In Part I of this series, I discussed the current over-reaction on the left to the Trump Administration’s desire to reduce the rising costs of Medicaid. We learned that Medicaid is actually the worst form of health insurance, even worse than no health insurance at all! But Democrats have been eager to expand the rolls of Medicaid since it puts more Americans under the control of the federal government when it comes to their healthcare. To achieve that goal, they have been willing to push the envelope of eligibility to the extremes, even declaring an emergency when none exists.

I explained this last statement in an earlier post in August, 2024. I will repost much of that information here so you will understand what is driving the costs of Medicaid out of control:

“Medicaid keeps on growing like kudzu vine in a forest. Kudzu grows like a wildfire out of control and the Biden government has no interest in stopping it. They actually want it to take over everything.

This process began with the Affordable Care Act of 2010, better known as ObamaCare, which the Obama Administration pushed through Congress without a single Republican vote. Medicaid eligibility was originally defined by the federal government as 133% of the Federal Poverty Level (FPL) for pregnant women and children six years and under, 100% of FPL for children seven to eighteen, 75% of FPL for the elderly and disabled and 25% of FPL for working parents. Childless adults were ineligible. Individual states may increase these levels but may not decrease them.

ObamaCare changed all that by establishing one federal definition of eligibility at 133% of FPL. It also enticed states to increase their Medicaid rolls by offering to increase the federal subsidy from a then current average of 57% of the costs to 100% of the costs for “newly eligible” people in 2014 for three years. Thereafter the subsidies would gradually decline to 90% in 2020, but none beyond that. Many states were sucked in by this incentive only to have buyer’s remorse when the rolls of their Medicaid population ballooned past expectations and they were left with huge debts in their state’s budgets. But the federal government was only too delighted to have more people on the rolls of Medicaid.

Then the Covid pandemic hit in 2020. This gave the new Biden Administration just the excuse they needed in 2021 to expand the rolls of Medicaid further. They extended the temporary expanded eligibility guidelines of the Trump Administration well beyond the pandemic crisis to allow millions of Americans to enroll in Medicaid who did not meet the economic eligibility guidelines.

Fast forward to today and now we see the Biden, or should I say Harris, Administration going further in their quest to expand Medicaid. Here is how the Wall Street Journal editorial board described it: “Kamala Harris this week praised North Carolina’s new plan to wipe out medical debt. What the Vice President didn’t say is that the Biden Administration is making taxpayers in the rest of America pay for it. Behold how the Administration is turning Medicaid into an entitlement for progressive policies far beyond healthcare for the poor.”

The Centers for Medicare and Medicaid Services last week approved North Carolina Democratic Gov. Roy Cooper’s plan to increase federal Medicaid reimbursements for hospitals that agree to forgive medical debt and discount future bills for low- and middle-income patients. Urging other states to follow, Ms. Harris promised to continue “to relieve the burden of medical debt.”

This could be an expensive proposition. Americans owe more than $220 billion in medical debt, though perhaps Ms. Harris considers it a pittance relative to the more than $800 billion in student debt the Administration has written down. Enter Mr. Cooper, who is dangling more Medicaid money for hospitals that waive debt accrued over the last decade by patients earning less than 350% of the poverty line—$109,200 for a family of four—or whose unpaid bills exceed 5% of their annual income. Hospitals will also have to provide large discounts for patients earning less than 300% of the poverty line.

Larger federal Medicaid payments would exceed the amount of potential debt relief. But this may still be a Faustian bargain for hospitals since debt relief could cause patients to skip out on future bills. Reducing patient payments for emergency visits could also spur more to go without insurance, resulting in more uncompensated care.

Why is this government so eager to enroll more Americans in Medicaid? This is all about expanding the welfare state to make more Americans dependent on the government. It is one more step toward socialized medicine, the complete government control of your healthcare. Don’t be fooled! When they are in complete control of your healthcare, they are in complete control of who gets treatment and who does not.”

Today, the Trump Administration is trying to reign in the costs of Medicaid that now exceed the Defense Budget. These costs have skyrocketed in the last 15 years, more than doubling from $402 Billion in 2010 to $894 Billion in 2024.It is clear that would be good for the country – and it would be good for the millions of Americans who find themselves stuck with Medicaid – the worst form of health insurance available.

Medicaid has been in the news a lot lately. Democrats would have you believe that Republicans, especially President Trump, are out to gut Medicaid. They want you to believe millions of people will die without Medicaid if this is allowed to happen.

There’s a Greek word for this – Hogwash! I’ve been writing about Medicaid since 2014 and it’s about time to set the record straight. Here’s what I said in 2014: “It is a favorite talking point of the left that the expansion of Medicaid will “save lives”. Liberal journalist Scott Maxwell of The Orlando Sentinel made this exact assertion recently in a column. It’s easy to see why Maxwell might believe that. Without information to verify that assumption, one would assume that giving people Medicaid insurance would improve their health and, in some cases, even save lives.”

But research often refutes our sincere assumptions. In 2008 the State of Oregon was faced with a dilemma. They wanted to expand Medicaid eligibility to more residents but they didn’t have enough money to pay for everyone. So they held a lottery for low-income, uninsured adults. This created an ideal situation for studying the impact of Medicaid in a randomized, prospective manner.

This study, known as The Oregon Health Insurance Experiment, is an ongoing study, which has already revealed significant information. Thus far, researchers have learned that having Medicaid does not improve health, at least in standard measurements of blood pressure, blood sugar, and cholesterol. Medicaid reduced observed rates of depression by 30% but increased the probability of being diagnosed with depression. Medicaid significantly increased the probability of being diagnosed with diabetes and the use of diabetes medication, but did not have the expected impact of lowering blood sugar.

It has always been postulated that the uninsured are more likely to use Emergency Rooms at hospitals for their health care than the insured. By this reasoning, expansion of Medicaid would lower the use of hospital Emergency Rooms and contribute to solving this chronic problem, which poorly utilizes health care resources and increases costs. Unfortunately, the Oregon study showed the opposite. Those with newly enrolled Medicaid were 40 percent more likely to use the Emergency Room than the uninsured. This means expanding Medicaid will actually exacerbate this problem and increase the cost of delivering health care.

How to explain this surprising truth? John C. Goodman, founder of The National Center for Policy Analysis, explains this in his book, Priceless. Goodman says having Medicaid may actually be worse than having no insurance at all. That’s because most doctors do not accept Medicaid patients and the ones who do often ration their appointments making waiting times very long. Medicaid patients respond by going to the Emergency Room where they are sure to be seen the same day.

So, Medicaid is actually the worst type of healthcare insurance in America. Yet, it continues to expand its enrollment. Medicaid has grown from about 52 million Americans in 2010 to 72 million in 2024. The cost of Medicaid has grown from about $402 Billion in 2010 to $894 Billion in 2024, more than doubling in 15 years. It now exceeds the Defense Department budget of $841 Billion. It has grown 7.9% just since 2023. Clearly, Medicaid costs are out of control.

What has caused this rapid expansion of the cost of Medicaid?

I will address this question in the next post.

In his recent address to both houses of Congress, President Trump brought new awareness to the number of children diagnosed with autism.  “Our goal is to get toxins out of our environment, poisons out of our food supply, and keep our children healthy and strong,” he said in his speech to Congress last week. “As an example, not long ago, and you can’t even believe these numbers, 1 in 10,000 children have autism. One in 10,000. And now it’s 1 in 36. There’s something wrong. One in 36.”

That’s an alarming increase and bears further attention. But understanding the cause of this increase is paramount to solving the problem.

Allysia Finley, writing in The Wall Street Journal, believes the president is going about it all wrong. She says, “Left-wing environmentalists have long exploited parents’ anxieties by stoking fears about “environmental toxins” harming their kids. Now President Trump is taking up their cause. Something is wrong, and it’s the information that has been fed to him by “radical left lunatics” like Robert F. Kennedy Jr.—the label Mr. Trump applied less than a year ago to the man who is now his health and human services secretary.”

The onus for this increase has been placed on vaccines in the past, although there is no scientific evidence to support these claims. The Centers for Disease Control and Prevention reportedly plans to conduct a study of vaccines and autism despite countless failed attempts to find a causal link. Many toddlers show traits associated with autism spectrum disorder, such as repetitive behaviors or sensitivity to noise, around the same age as they get vaccinated. This doesn’t mean vaccines cause autism, any more than higher CO2 emissions cause Category 5 hurricanes.

Finley believes the main causes of increasing autism rates are heightened public attention and broader diagnostic criteria, which have encouraged more diagnoses of children and young adults who wouldn’t have been labeled autistic decades ago. Bill Gates notes in his new memoir, “Source Code,” that if he were a kid today he would likely be diagnosed on the autism spectrum because he was hyperfocused and struggled to read social cues. Kids may get diagnosed as on the spectrum if they are late to start talking or insist on following routines like sticking to a set bedtime. Suggesting that autism is a result of “toxins” stigmatizes people who happen to be wired differently.

The 1-in-10,000 statistic the president cited derives from a 1970 review of Wisconsin kids in the 1960s. In those days, only those who struggled to function were diagnosed. Most needed special education and accommodations, which they often didn’t get in public schools because it was expensive.

In 1973 Congress passed a law requiring schools that receive federal funds to make special accommodations for students diagnosed with disabilities, including autism. Two years later, Congress required states to identify such kids proactively and gave schools more money for each student who was diagnosed as disabled.

Whenever the government throws money at a program, you can be sure there will soon be more of that. The predictable result: a sharp uptick in autism diagnoses during the 1980s and 1990s as schools chased federal dollars. Some of these students needed special education, but many didn’t. Congress changed the funding formula in the late 1990s because many schools were diagnosing unimpaired children with cognitive disabilities to get more federal money.

Many states also give schools more money when their students are diagnosed on the spectrum. A 2022 study found states that do so had more diagnoses. According to government data, nearly 1 in 6 public-school students in 2022 were diagnosed as having a disability. But do they really? A study last autumn found that prevalence of autism more than tripled among children and young adults between 2011 and 2022. Don’t blame vaccines. Autism diagnoses increased most sharply in 2021 and 2022 even as MMR vaccination rates among kids fell.

Incentives can be powerful. Students diagnosed with autism, ADHD and learning disabilities typically get 50% more time to complete the ACT test. Some students may legitimately need such accommodations, but many are gaming the system.

An autism diagnosis can also yield more government benefits, including Supplemental Security Income. One study found that the prevalence of autism among young adults on Medicaid increased by about 50% between 2008 and 2012, which coincided with the economic downturn that left many out of work.

Finley concludes: “Jay Bhattacharya, Mr. Trump’s nominee to lead the National Institutes of Health, last week told the Senate that he was convinced that vaccines don’t cause autism, but that he would nonetheless “support a broad scientific agenda based on data to get an answer” to what does. By all means, study the genetic underpinnings. But please, Mr. President, don’t fuel public alarm.”

Clearly there is a need for further scientific study of the causes of autism and we should always be mindful of unintended consequences when we incentivize bad behavior. I look forward to learning more about this issue.