It is crunch time on Capitol Hill for Republicans trying to finish President Donald Trump’s “Big Beautiful Bill” before they recess for August. If the final legislation is to be fiscally sound, it must slow the growth of federal spending. There is no way to do that without reforming Medicaid. Nowhere is the problem with Medicaid made clearer than in New York, where out-of-control spending now finances more than 620,000 home healthcare jobs, making it the most common profession in the state.

Social Security and Medicare make up larger components of federal spending, but Medicaid is growing far faster than either of those programs. The urgent problem is in the way Medicaid is administered and financed.