Josh Hawley Is Wrong About Medicaid Reform

Senator Josh Hawley recently published an op-ed opposing Medicaid reform, claiming that cutting the program is politically suicidal and morally wrong. He could not be more mistaken.

Medicaid is one of the fastest-growing drivers of our national debt. According to the House Freedom Caucus, if we continue on this trajectory, entitlement programs like Medicaid will push us past $50 trillion in debt within a decade. Reform isn’t just an option.

It’s a necessity.

Medicaid was created in 1965 to serve the truly needy—the elderly, disabled, and very low-income families. But over the decades, its scope has ballooned far beyond that.

Thanks to Obamacare-era expansions, millions of able-bodied adults with no dependents are now on Medicaid. In fact, these able-bodied adults now outnumber the truly needy in many states.

This is not sustainable, and it certainly wasn't the original intent.

Myth: Reforming Medicaid Hurts the Working Class

Hawley paints a picture of working-class Americans suffering under proposed reforms. But the truth is, Medicaid has drifted far from its original purpose. The expansion of the program has led to skyrocketing costs and widespread abuse.

According to the Foundation for Government Accountability (FGA), when Arkansas implemented work requirements for Medicaid, more than 18,000 able-bodied adults left the program—many because they found employment or gained access to employer-based health insurance.

The result? A stronger workforce and fewer people dependent on government.

Reform helps restore Medicaid to a program for the truly needy, not a lifestyle subsidy for those who are capable of providing for themselves. By prioritizing the vulnerable—children, the elderly, and the disabled—we protect those who cannot protect themselves, while encouraging those who can work to do so.

This is both fiscally responsible and morally sound.

Myth: Work Requirements Are Punitive

Hawley warns that work requirements would lead to coverage losses. He’s right—and that’s the point. Work requirements are designed to encourage able-bodied adults to take steps toward independence.

The goal isn't to take away healthcare arbitrarily; it's to incentivize work, training, or volunteer service as a pathway out of government dependency.

Again, the data backs this up.

In states that have implemented these policies, many enrollees didn’t lose coverage because they were forced out—they left because they no longer needed the program. They found jobs. They gained self-reliance. They stopped relying on taxpayers to fund their daily needs. That is a win for them, for taxpayers, and for the country.

And let’s be clear: work requirements are not extreme. Most Americans support them.

A 2023 poll by the Opportunity Solutions Project found that 73% of voters support work requirements for Medicaid, including majorities of Republicans, independents, and even Democrats.

It’s a mainstream idea with proven results. What’s out of touch is the idea that it’s compassionate to keep people trapped in permanent dependency.

Myth: Cuts Are Political Suicide

What is actually politically suicidal is pretending we can fund endless welfare programs with money we don’t have.

Medicaid already consumes over $700 billion a year, and that number is climbing.

According to Cato Institute analysis, total Medicaid spending grew from $206 billion in 2000 to over $728 billion by 2021. Without reform, it will consume an ever-larger share of federal and state budgets, squeezing out everything else.

Meanwhile, the government borrows roughly $1 trillion every 100 days. That level of spending is not sustainable. It undermines our economy, weakens the dollar, and burdens future generations with unspeakable debt.

Eventually, the bill comes due—and the longer we wait, the more painful the reckoning will be.

Republicans have an obligation to lead on fiscal responsibility.

Kicking the can down the road is cowardice, not compassion.

Real leadership means telling the truth: we cannot maintain a massive welfare state and still expect liberty, growth, and solvency.

Myth: The GOP Must Choose Between People and Profits

Hawley frames this debate as a moral choice between helping people and helping corporations. That’s a false dichotomy.

A limited government that protects life, liberty, and property serves all people.

The best way to help low-income Americans is not through bloated bureaucracy but by removing barriers to opportunity and unleashing the private economy.

Let’s not forget, Medicaid expansion has created perverse incentives for states and healthcare providers. Hospitals and insurance companies lobby for more Medicaid dollars not because they care about the poor, but because it pads their bottom line.

This isn’t charity—it’s a government-sponsored cartel. Ending wasteful spending and restoring market forces would do more for healthcare access and affordability than any expansion of Medicaid ever could.

Besides, if corporate subsidies are the concern, then end them.

Cut cronyism. Don’t use it as an excuse to prop up a failed welfare model.

Conservative reformers can walk and chew gum at the same time: end the handouts to big corporations and reform Medicaid.

A Conservative Vision for Healthcare

The long-term conservative vision isn’t just to trim Medicaid.

It’s to decentralize it.

To give states full flexibility.

To promote direct primary care.

To empower patients through price transparency, competition, and portability.

Medicaid work requirements are a step in that direction—a small push toward a bigger goal: a healthcare system where individuals are in control, not bureaucrats.

Rather than pouring more taxpayer money into failing systems, conservatives should embrace policies that reward work, reduce red tape, and unleash innovation.

Whether that’s expanding Health Savings Accounts (HSAs), removing Certificate of Need (CON) laws, or breaking up monopolistic hospital systems, the path forward isn’t more Medicaid.

It’s more freedom.

Senator Hawley says we should not touch Medicaid.

But doing nothing guarantees collapse.

Conservatives must have the courage to tell the truth: Medicaid must be reformed, and that includes work requirements, tighter eligibility, and a return to its original intent.

We cannot continue pretending that every new welfare expansion is a moral necessity.

True compassion isn’t measured in dollars spent or lives enrolled in government programs. It is measured in lives changed, in people lifted out of poverty, in futures reclaimed through responsibility and work.

Big government is not compassionate.

Dependency is not dignity.

Reform is not cruelty—it is the only responsible path forward.

Senator Hawley may believe that Medicaid cuts are politically unwise, but the greater danger is in failing to act.

America cannot afford to wait.