This Thanksgiving, Americans have much to be thankful for following a massive tax cut and the elimination of wasteful spending in the “one big, beautiful bill.” Indeed, the House Ways and Means Committee announced on Nov. 17 that tax refunds in 2026 will total $191 billion, which could be the largest refund in history.
While the welcome relief from years of high taxation and inflation under the Biden administration will make everything more affordable for taxpayers, more must be done to get spending under control.
The list of programs on the chopping block for a second helping of reconciliation should begin with a multibillion-dollar boondoggle that emerged from the Affordable Care Act: the Center for Medicare and Medicaid Innovation.
CMMI was intended to serve as an “offset” to some of the costs created by the Affordable Care Act, by developing “models” that were supposed to save money and improve care in Medicare, Medicaid, and the Children’s Health Insurance Program. Instead, like many other well-intended federal programs, CMMI has a track record of failure.
The backroom bureaucrats at the Centers for Medicare and Medicaid Services, which runs CMMI, have created more than 50 models for 28 million patients and more than 528,000 healthcare providers, but only six of these models have either not increased spending or reduced the quality of healthcare.
Under the Affordable Care Act, CMMI gets $10 billion in mandatory funding every decade. This unaccountable slush fund has consistently failed to achieve its objectives of lowering costs and improving care. The reported losses are likely higher, as CMMI does not account for the administrative burdens its policies place on healthcare providers.
Regardless of its results, CMMI receives an automatic check for $1 billion every year, without Americans’ elected representatives in Washington appropriating those funds or weighing in on the ensuing changes to healthcare policy.
A September 2023 Congressional Budget Office study found that instead of saving an initially projected $2.8 billion between 2011 and 2020, CMMI cost American taxpayers $5.4 billion. The CBO’s projection for 2021-2030 shows that another $1.3 billion will be lost this decade.
Reconciliation bills are a key opportunity to rein in mandatory spending, which is not part of the annual appropriations process and therefore continues to be funded until Congress changes the underlying statutory authority.
Since it is easier to do nothing, Congress is often reluctant to reform these programs, which include Medicare and Medicaid. But there are many reforms that can be adopted to improve the finances of both programs without disrupting the vital care they provide.
This should be an obvious decision when a program such as CMMI costs instead of saving money. And voters across America agree that something must be done.
An October survey of 1,600 voters found significant bipartisan support for changes in how CMMI operates, as well as widespread objections to its wasteful spending. Only 29% believe CMMI’s $10 billion budget is an appropriate use of taxpayer dollars.
The survey found that 76% of voters believe Congress should increase oversight of CMMI, and 77% believe there should be more guardrails in place to protect patients and providers from CMMI’s mandatory, one-size-fits-all policies.
And 78% of voters are concerned that CMMI increases government influence and control over personal healthcare decisions that should be left up to patients and their doctors. Americans do not want government-run healthcare or bureaucrats tinkering with their coverage with zero accountability.
DOWNSIDE OF $2,000 TARIFF DIVIDEND CHECKS: INFLATION
Just as more of the benefits of the “one big, beautiful bill” start to kick in, the Republican majority in Congress will again have the opportunity to demonstrate fiscal restraint and responsibility by enacting another reconciliation bill.
Since affordability is the mantra on both sides of the aisle, House and Senate leadership, working with the White House, can make a commonsense decision about reducing healthcare costs. They should listen to the bipartisan majority of Americans who understand innovation comes from individuals and businesses, not bureaucrats, and restrain and ultimately defund CMMI before another $1 billion is burned.
Tom Schatz is the president of the Council for Citizens Against Government Waste.
