I have heard a lot of discussion about the potential ramifications of the One Big Beautiful Bill over the last few weeks. I bet you have, too.
Here’s something I’d wager you haven’t heard much about: of about 340 million Americans, 83 million are on Medicaid.
That’s one-fourth of us.
Forty percent of American children are on Medicaid. Forty percent!
Try to wrap your head around those figures. One in four of us has his healthcare paid for by the other three, who are also paying for their own healthcare. Two of every five children in the country have been brought into the world by people who are not in a condition to provide them healthcare, so the rest of us pick up the tab, in addition to paying for the healthcare of our own children.
If one adheres to broadly Christian principles, he should not object to helping people in demonstrable need—that is, those who, for reasons completely out of their control, genuinely cannot do for themselves or those close to them. But if we truly live in a society in which a quarter of us are incapable of providing for our most basic needs—something would seem to be dreadfully wrong. Something must be wrong with us.
In other words, something is wrong with some portion of that quarter of Americans who are perfectly able-bodied but cannot get themselves together sufficiently to handle even this basic aspect of adult life. And something must be wrong with those of us outside that quarter who think so little of that portion of able-bodied recipients that we consider them incapable and prefer, instead, to subsidize and infantilize them.
A closer look at usage of Medicaid and the Children’s Health Insurance Program (CHIP) is informative. The dependence on Medicaid is disproportionately high among blacks and Latinos, although white rates of dependence are also unacceptably high. Non-Hispanic whites are around 60 percent of the American population, and 43 percent of Medicaid/CHIP users. Latinos are 19 percent of the population, and 28 percent of Medicaid/CHIP users. Blacks are 12 percent of the population and 21 percent of the Medicaid/CHIP users. Any society with even the slightest interest in cultivating self-reliance and responsibility in its population would wonder about these figures and endeavor to lower them. In the United States today, however, our media seldom mentions any of these facts.
Indeed, whenever someone raises the questions I am addressing here, you can reliably count on the standard narratives of victimhood, structural inequality, and white supremacy being trotted out, and you know at that point what you will be called if you even dare to ask for the evidence supporting those interpretations of the situation.
Fearmongering about the One Big Beautiful Bill from the left typically centers on those currently receiving Medicaid who, leftists insist, “will not be able to navigate the red tape” required to show they meet new work requirements. But why won’t they be able to navigate this? Why shouldn’t they have to prove their eligibility? In advancing these arguments, aren’t they admitting these people are not competent to function in the adult world?
The Affordable Care Act expanded Medicaid to everyone up to 138 percent of the poverty rate. What this means is that, if you are by definition not poor, but insufficiently far away from poor to satisfy the desires of progressive elites, you can get still Medicaid. Why are people who are not at poverty level getting taxpayer-supported healthcare that was meant for the poor? And why is the Trump administration’s attempt to undo this error viewed as some kind of moral monstrosity? Since when do we not require non-poor people to provide these basics for themselves?
The fact that there are this many Americans on the healthcare dole, frankly, should embarrass and shame the whole country. It is an indication that we have given up on the project of morally training our citizens to avoid relying on the state for their basic needs.
Walking around my middle-class neighborhood, I see yard signs reading “Hands off Medicaid.” I have perfect confidence that none of the solidly middle-class households that put those signs up on their lawns are receiving Medicaid. I have nearly as much confidence that none of them even know anyone who is receiving Medicaid, nor do they know how many Americans are on Medicaid. They have drunk the Kool-Aid our leftist political elites have mixed up for them on this issue. They believe the plain falsehood that the One Big Beautiful Bill is somehow relegating helpless people to the poor house merely by requiring Medicaid recipients to justify their presence on the rolls.
By contrast, I grew up poor, and I have known other poor people. The single thought that most dominated my consciousness for much of my youth was, “Being poor is a drag, I do not like it, so I am going to do everything I can to get myself out of this, and I am confident that if I commit myself to that goal, it can be reached.” I applied myself consistently to hard work in school and in all the various jobs I could get to help me accomplish that goal. I do not believe my story is anything particularly special or unique. Unlike the patronizing left, which thinks of those at the bottom of the social hierarchy as grown-up children who are too incompetent to handle life, I give others enough credit as human beings to believe they are capable of rising out of poverty. I refuse to believe that we must bail them out and make excuses for them when they do not do what is necessary to make themselves independent.
Some people will fall into unfortunate circumstances beyond their control, and we have a moral obligation as a society to help them get back on their feet. But when 25 percent of us are on Medicaid and many, if not most, of them are perfectly able-bodied and capable of supporting themselves, we have to begin to wonder whether our elite class simply finds it desirable to infantilize people in this way. If we can’t even ask people receiving public funds to prove their indigent status, we have a problem.
Alexander Riley is a professor of sociology at Bucknell University in Pennsylvania and serves on the Board of Directors of the National Association of Scholars. All views expressed are his and do not represent the views of his employer.
