Democrats are hoping that healthcare will propel them to victory in this year’s midterm elections. Their central charge is that Republicans have cut Medicaid by $1 trillion over 10 years as part of the One Big Beautiful Bill signed into law by President Donald Trump back in July.
There’s just one problem with that claim. It’s not true. A new report from the non-partisan Congressional Budget Office confirms as much.
The CBO now projects that federal Medicaid spending will exceed $7.1 trillion between 2026 and 2034. The agency points to “technical changes” that will increase spending by $700 billion over the coming decade.
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In other words, Medicaid outlays are projected to increase in absolute terms over the next decade. But they’ll rise at a slightly lower rate than the CBO previously projected. Hence, Democrats’ accusation of “cuts.”
During the Biden administration, Medicaid enrollment surged, aided by pandemic-era policies that limited states’ ability to remove ineligible beneficiaries.
The result, predictably, was a spending extravaganza. In January 2025, just before Trump took office, the CBO revised its ten-year projections for Medicaid spending up by more than $1.2 trillion, compared to its 2021 baseline.
The One Big Beautiful Bill tries to moderate that trajectory by tightening eligibility standards and implementing modest work requirements for able-bodied adults. Those changes will slow projected growth. But they will not cut overall spending.
There’s plenty to cut. By one estimate, Medicaid made nearly $1.1 trillion in improper payments between 2015 and 2024.
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Medicaid now covers roughly one in five Americans. It was designed as a safety-net program for the poor, elderly, and disabled — not an ever-expanding entitlement with limited oversight.
Calling slower spending growth a “cut” may be politically useful. But it’s misleading — and puts Medicaid’s long-term sustainability at risk.
Sally C. Pipes is President, CEO, and Thomas W. Smith Fellow in Health Care Policy at the Pacific Research Institute. Her latest book is The World’s Medicine Chest: How America Achieved Pharmaceutical Supremacy—and How to Keep It (Encounter 2025). Follow her on X @sallypipes.
