The Truth About The Medicaid Cuts
Why Personal Responsibility and Fair Reform Are Essential to Protecting Our Healthcare Safety Net
I’ve been paying attention to the conversation about Medicaid for a while now. What finally got me writing was the wave of headlines shouting that 17 million people are about to lose coverage. Most of them point to the Medicaid changes in the “One Big Beautiful Bill,” the budget proposal supported by President Trump and House Republicans. The way it’s presented, you’d think 17 million people are just being kicked off at random. There’s no context, just a big number meant to scare. I didn’t buy it, so I read the bill.
When the media leads with panic instead of facts, they don’t solve problems, they just stir the confusion.
Let’s get something straight. No serious administration, Democrat or Republican, is trying to rip healthcare away from hardworking Americans. (Socialist Democrats do often expand government dependence, but that’s another conversation.) The real conversation here is about how we keep Medicaid strong and fair, not about gutting it.
Medicaid today covers over 70 million people: children, seniors, people with disabilities, and families just trying to get by. It’s a program worth protecting. But protecting something doesn’t mean pretending it’s perfect. It means being willing to reform it responsibly, so it works better for those who need it now and those who will in the future.
The Medicaid reforms in the “One Big Beautiful Bill” don’t target the most vulnerable. They focus on able-bodied adults without dependents, a group that grew under pandemic-era rules. The bill requires these adults to complete at least 80 hours per month of community engagement—such as work, volunteering, caregiving, or education—to maintain eligibility. This isn’t punishment; it’s a reasonable expectation to promote dignity and pride through contribution.
Additionally, the bill tightens eligibility by requiring states to verify Medicaid status every six months instead of annually, ensuring that taxpayer dollars go to those who truly qualify. Some states will also have the option to implement small premiums or co-pays—up to $35 per healthcare service—for enrollees with incomes between 100% and 138% of the federal poverty level. These measures encourage shared responsibility without punishing the most vulnerable.
Now, rural providers have raised valid concerns. Medicaid keeps a lot of small-town hospitals afloat, and reform must never cut off essential care. In many rural areas, a large share of patients rely on Medicaid, and those reimbursements help cover the day-to-day costs of keeping hospitals open. Without them, rural hospitals would be forced to absorb the cost of care for uninsured patients, something most can’t afford. The writers of the bill anticipated this. That’s why it includes a $50 billion Rural Hospital Fund to support healthcare providers in rural areas and provide a safety net for affected communities.
Make no mistake, hospital executives may not like this all that much either. Hospitals have been known to bill patients with Medicaid outrageously. Over-billing is real. It turns out the government asks less questions than private insurance.
And here’s another thing we need to clarify: Medicaid is not the same as welfare. It’s a healthcare program. But it’s often tossed into the same conversation as programs like TANF and SNAP. Those programs have their own challenges, and they also deserve reform, but for different reasons.
Medicaid should be, and will be there for the disabled, for seniors, and for families who’ve fallen on hard times. But when it comes to welfare, especially income support, the goal should be to help people get back on their feet, not to keep them stuck.
Back in the 1990s, President Bill Clinton worked with a Republican Congress to pass welfare reform that tied benefits to work. It wasn’t perfect, but it helped millions move from dependency to self-sufficiency. That approach worked because it was about accountability, not cruelty. It was about offering a hand up, not a handout.
That’s the kind of thinking we need today. I believe we don’t lift people up by lowering expectations. We lift them up by telling them they are capable of more. That’s not harsh. That’s hopeful. America needs all of us.
Now, I know some people worry that reform efforts are just politics. That expanding public programs is about building voting blocs. That may be true in some corners, but most Americans, regardless of party, want a system that rewards effort, protects the vulnerable, and doesn’t encourage more people to live off the government when they don’t need to. That’s a fair deal.
Medicaid reform shouldn’t be about fear. It should be about fairness. It should be about making sure the program survives for those who truly need it, while helping others find their way to something better. That is what I believe Trump’s “One Big Beautiful Bill” has done. That is, promote personal responsibility and ensure access for those most in need.
We need a country where public programs are there when you fall, but don’t hold you down when you’re trying to get back up. That’s not a partisan idea. That’s an American one.
As President John F. Kennedy once said, “Ask not what your country can do for you, but ask what you can do for your country.” That spirit still applies. When we pair compassion with responsibility, we get better outcomes for everyone.
About the Author
I’m Steldon H. Posey, a native of the Ozarks, raised in Branson, Missouri, and a recent graduate of the University of Arkansas with a degree in history. In the fall, I will begin a dual program at the Clinton School of Public Service and the Bowen School of Law in Little Rock, Arkansas. I am deeply committed to upholding constitutional principles, advancing individual liberty, and ensuring equal justice under the law. Through public service and the legal profession, I aim to be a steadfast advocate for a freer, fairer society.
Disclaimer:
All opinions are my own, unless otherwise stated.