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The Federal Budget: Spending, Taxes, and Debt

OBBB Myth vs. Fact: Medicaid “Cuts” Are Just Washington Math

The Federal Budget: Spending, Taxes, and Debt Policy Rapid Response BlogAugust 4, 2025 By Matthew Dickerson
Medicaid welfare spending has grown out of control, driven by waste, fraud, and abuse. Improper payments made by the Medicaid program alone have totaled $1.1 trillion over the last decade. The One Big Beautiful Bill makes important improvements to Medicaid to address these problems and deliver better care for truly vulnerable Americans.

What the OBBB Actually Does

The Medicaid reforms in the OBBB are common sense. The legislation:

Medicaid Spending Grows Every Year

Despite unfounded claims about “cuts,” Medicaid spending is projected to grow each year over the next decade. After implementation of the OBBB, Medicaid spending would grow from $618 billion in FY 2024 to $807 billion in FY 2034. Only Washington, DC, politicians would try to claim that a 31% increase in annual spending is a “cut.” By FY 2034, Medicaid spending would be nearly double the FY 2019 pre-COVID spending level. Medicaid OBBB Growing Spending 7.25.2025

Biden Policies Caused Medicaid Spending to Skyrocket

President Biden’s policies caused Medicaid spending to skyrocket. Medicaid outlays are 60% higher in FY 2025 than they were in 2019. The Congressional Budget Office (CBO) projects that Medicaid spending would have been $1.2 trillion higher between FY 2025 and 2034 compared to the pre-Biden baseline. This spending increase was driven by waste, fraud, and abuse. Throughout and even after the COVID-19 pandemic, the federal government paid states to keep millions of ineligible individuals on the Medicaid rolls. The Biden Administration then implemented the “Maintaining Enrollment in Medicaid Rule” to restrict states from cleaning up their rolls and verifying eligibility. Medicaid Biden Baseline Grows 1.2 Trillion 7.25.2025

The OBBB Puts Medicaid on a More Sustainable Path to Protect the Truly Vulnerable

The OBBB makes important reforms that will address Medicaid waste, fraud, and abuse. By closing these loopholes, the OBBB will ensure that resources are available for those most in need of care, restoring the original intent of the program.

Author

Matthew D. Dickerson

Matthew D. Dickerson

Director of Budget Policy

Matthew D. Dickerson is Director of Budget Policy at the Economic Policy Innovation Center (EPIC). Dickerson is recognized as an expert on fiscal policy issues, including the budget, appropriations, and entitlement reform. His articles have been featured in the Wall Street Journal , the Miami Herald , National Review , the Sacramento Bee , the Washington Times , the Baltimore Sun , The Hill , the Washington Examiner , and other outlets. Prior to joining EPIC, Dickerson served as Senior Policy Advisor on the staff of the House Budget Committee, where he helped lead development of the fiscal year 2024 budget resolution. He has a dozen years of experience on Capitol Hill, including as a senior staffer with the Republican Study Committee (RSC), the caucus of conservatives in the House of Representatives. Under four different RSC chairmen, Dickerson held senior level roles including Policy Director and Senior Policy Staff. Additionally, he served as Legislative Director and other policy positions for the late Congressman C.W. Bill Young (R-FL), a former Chairman of the powerful House Appropriations Committee. During his tenure at The Heritage Foundation, Dickerson was Director of the Grover M. Hermann Center for the Federal Budget. In this capacity, he oversaw a team of budget analysts and economists researching diverse subjects including spending, entitlements, budget process, tax, labor, pensions, and infrastructure issues. He has also been a Policy Manager at Americans for Prosperity, where he supervised a team of fellows and analysts covering a variety of federal and state policy issues. Dickerson is a graduate of the College of William and Mary in Virginia and holds a Bachelor of Arts in Government and History.

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