{"id":3909,"date":"2025-09-08T03:21:28","date_gmt":"2025-09-08T03:21:28","guid":{"rendered":"https:\/\/gunowner-news.com\/?p=3909"},"modified":"2025-09-08T03:21:28","modified_gmt":"2025-09-08T03:21:28","slug":"the-only-way-to-save-money-on-medicaid-is-to-let-people-die","status":"publish","type":"post","link":"https:\/\/gunowner-news.com\/?p=3909","title":{"rendered":"The Only Way to Save Money on Medicaid Is to Let People Die"},"content":{"rendered":"


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\n One of the trauma bays at South Shore University Hospital in Bay Shore, New York, on August 7, 2024. <\/span>\u00a0Photo: John Paraskevas\/Newsday RM via Getty Images<\/span> <\/figcaption><\/figure>\n
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Michael Kinnucan is the Senior Health Policy Advisor at the Fiscal Policy Institute.<\/p>\n<\/div>\n

One of the major<\/span> policy ideas animating the One Big Beautiful Bill Act (OBBBA) was the notion that the federal government was wasting money providing Medicaid to healthy adults. OBBBA addressed this supposed problem by instituting work requirements for non-disabled adult Medicaid enrollees \u2013 a red tape obstacle course that will cause an estimated 10-15 million people<\/a> to lose federal Medicaid coverage.\u00a0<\/p>\n

This will occur even though the vast majority<\/a> of those who will become uninsured already satisfy the new work requirements. Most adult non-disabled adult Medicaid enrollees already work, but experience in states like Georgia shows that many will struggle to prove that fact to a government bureaucracy every six months.<\/p>\n

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In principle, state governments could step in to prevent this by covering those who lose federal Medicaid using state-only dollars. But even deep-blue New York, where I live, seems unwilling to do so: Governor Kathy Hochul has already announced that New York can\u2019t afford to \u201cbackfill\u201d federal cuts. So states are likely to attempt to save money by kicking people off Medicaid.<\/p>\n

It won\u2019t work \u2013 states can\u2019t save money this way. The trouble with attempting to save money by denying people insurance is that some of the people involved are healthy, and don\u2019t cost money, while others are sick, and will flood hospital emergency rooms if they don\u2019t have insurance.<\/p>\n

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You can\u2019t save money by denying healthy people healthcare, because healthy people aren\u2019t the ones using healthcare.<\/p>\n<\/blockquote>\n<\/figure>\n

You can\u2019t save money by denying healthy people healthcare, because healthy people aren\u2019t the ones using healthcare. That\u2019s true in private insurance, where 80 percent of healthcare spending goes to the sickest 20 percent of the insured population. And it\u2019s true in Medicaid, too: The vast majority of Medicaid spending goes to providing healthcare<\/em> to sick people<\/em>.\u00a0<\/p>\n

Merely enrolling someone in Medicaid, after all, costs almost nothing at all; you update the state database, you mail them a card, you\u2019re all set. What costs money is providing healthcare when they get sick. Hospital visits, specialist treatment, chemo, prescription drugs \u2013 that\u2019s where the money goes. It\u2019s when someone gets hit by a bus, or gets a cancer diagnosis, or suffers from diabetes, that covering them on Medicaid begins to cost money.<\/p>\n

Now, most of the people targeted by Trump\u2019s work requirements are not currently <\/em>sick, just as most people with private health insurance are not currently <\/em>sick. But precisely because they\u2019re not sick, they cost the Medicaid program virtually nothing \u2013 maybe a couple of hundred dollars a year for an annual checkup. You can\u2019t save any meaningful amount of money by kicking them off the program.<\/p>\n

If you want to save money, you need to deny healthcare <\/em>to sick people. <\/em>As politically unappealing as it may be to deny insulin to diabetics, or to refuse chemotherapy to cancer patients, it\u2019s really the only option to achieve savings. Remember that rule of thumb about how 80 percent of the money goes to treat the sickest 20 percent of enrollees; if policymakers want to achieve savings, they need to be laser-focused on not paying for healthcare for those sickest 20 percent.\u00a0<\/p>\n

And policymakers could certainly pursue that option! There is a foolproof way to save money on Medicaid, which is to let sick people who are kicked off Medicaid simply die in the street. When a guy rolls into the ER on a gurney after a traffic accident, we as a society could shrug and say \u201che didn\u2019t properly fill in the paperwork to show his employment status back in March, so he\u2019s out of luck,\u201d and let him bleed out. We\u2019d have saved perhaps hundreds of thousands of dollars in ICU costs at a single stroke.<\/p>\n

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But there are substantial practical problems with this approach to saving money on Medicaid, which are that (1) it\u2019s morally reprehensible, (2) it\u2019s politically toxic, and (3) it violates long-established state and federal law regarding hospitals\u2019 obligation to provide emergency care.\u00a0<\/p>\n

Because of these practical obstacles, politicians have hunted for other approaches to disguise what they\u2019re doing. They require hospitals to treat uninsured people in emergencies, and provide billions in state and federal funding to compensate them for that care. They pass laws like the Big Beautiful Bill Act that kick millions off Medicaid, but add carveouts<\/a> for those with \u201cserious or complex\u201d medical conditions. And then they tell the public \u201cwell, we\u2019ll cut off Medicaid, but only to healthy people.\u201d We\u2019re going to achieve some Medicaid savings, yes, but we\u2019re not monsters; we won\u2019t let people die in the street.<\/p>\n

But there\u2019s just no way to do this. The money goes to pay for healthcare for sick people. Either we won\u2019t provide it, and we\u2019ll achieve savings (but they\u2019ll die), or we will provide it, and we won\u2019t achieve savings (but they\u2019ll live).<\/p>\n

So which will it be?<\/p>\n

Under the new regime post-OBBBA, we\u2019ll no doubt see a little of both. Some people will certainly die<\/a> because they\u2019re kicked off Medicaid. Many others will get care despite being uninsured \u2013 once they get seriously ill, they\u2019ll end up in the ER and be legally entitled to treatment, or their illness will qualify them for a disability or \u201cmedically fragile\u201d exemption from work requirements, and they\u2019ll get back on Medicaid. In either case, state governments will ultimately pay for their care.\u00a0<\/p>\n

In these cases, our political system will have succeeded in generating the stupidest possible outcome: Keeping people off Medicaid until they get sick. <\/em>We\u2019ll be forcing people to endure a stressful bureaucratic nightmare, encouraging them to skip primary care, skimping on chronic disease management for diabetic and asthmatic patients, and all for naught: We still pay for their care. We may well pay more <\/em>for their care as unnecessary hospitalizations increase.<\/p>\n

Which is all to say that while the idea of saving money by denying healthcare to healthy people may be politically appealing, it\u2019s a will o\u2019 the wisp. If you want to save money you have to let sick people die \u2013 and if that\u2019s what you want to do, say it clearly. If you want to make sure sick people don\u2019t die, then you\u2019re going to pay for it, one way or the other \u2013 so you might as well keep people insured.\u00a0<\/p>\n<\/p><\/div>\n


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One of the trauma bays at South Shore University Hospital in Bay Shore, New York, on August 7, 2024. \u00a0Photo: John Paraskevas\/Newsday RM via Getty Images Michael Kinnucan is the Senior Health Policy Advisor at the Fiscal Policy Institute. One of the major policy ideas animating the One Big Beautiful Bill Act (OBBBA) was the […]<\/p>\n","protected":false},"author":1,"featured_media":3910,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[9],"tags":[],"class_list":{"0":"post-3909","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-usa-news"},"_links":{"self":[{"href":"https:\/\/gunowner-news.com\/index.php?rest_route=\/wp\/v2\/posts\/3909","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/gunowner-news.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/gunowner-news.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/gunowner-news.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/gunowner-news.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=3909"}],"version-history":[{"count":0,"href":"https:\/\/gunowner-news.com\/index.php?rest_route=\/wp\/v2\/posts\/3909\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/gunowner-news.com\/index.php?rest_route=\/wp\/v2\/media\/3910"}],"wp:attachment":[{"href":"https:\/\/gunowner-news.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=3909"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/gunowner-news.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=3909"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/gunowner-news.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=3909"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}