AP/Jacquelyn Martin
Kamala Harris’ plans for America’s health-care system are, like the rest of her agenda, a mysterious enigma.
But the biggest clue to her intentions is surely her budget-busting support for ObamaCare — and that should terrify taxpayers.
According to our new research, ObamaCare’s Medicaid expansion has cost more than $1 trillion over the past 10 years — an unaffordable tab that will grow even faster under a Harris administration.
Medicaid expansion was the centerpiece of the 2010 Affordable Care Act, popularly known as ObamaCare. It remains the Democratic Party’s template for health-care reform, including Harris’ since-reversed 2019 promise to enact “Medicare for All.”
The policy rests on the idea that the federal government can effectively provide affordable coverage to every American. Since 2014, 40 states and Washington DC have bought into this lie by adding millions of able-bodied adults to the program’s rolls.
The Biden-Harris administration has cheered Medicaid expansion, while pushing holdout states to get on board. But neither Harris nor her boss have paid any mind to the staggering price tag.
States expected that extending Medicaid coverage to non-disabled, higher-income adults would cost taxpayers about $450 billion up to this point.
Instead, their cost overruns have reached $574 billion and counting — more than double what they anticipated.
The red ink is growing faster, too: We found that expansion cost 180% more than anticipated in 2023 alone.
For Democrats like Harris, the cost overruns are a feature, not a bug, reflecting the reality that more people are signing up for government-run coverage.
States initially estimated that only 6.5 million able-bodied adults would join the expanded program, while private estimates put the total at 8.6 million.
Yet by the end of 2023, more than 23 million able-bodied adults had enrolled.
They’re competing with the truly needy Americans who Medicaid was designed to help, leading to longer wait times and worse health outcomes in many cases.
The Biden-Harris administration has actively made this crisis worse.
In 2021, the administration began revoking waivers that allowed states to attach work requirements to able-bodied adults covered by Medicaid expansion, then told states that such requirements wouldn’t be allowed going forward.
Yet work requirements would have encouraged able-bodied adults to find jobs, saving billions of dollars by getting them onto private insurance.
Today, not a single one of those 23 million able-bodied adults is required to work — and our organization’s analysis of state data shows that 60% of them aren’t working.
If elected president, Harris is all but certain to continue this assault on taxpayers.
Her party opposes work requirements, and she’d likely push the 10 holdout states to expand Medicaid, perhaps forcing their hand through legislation or regulation.
We estimate this would cost at least another $670 billion over a 10-year span, adding another 11 million able-bodied adults to Medicaid.
If Harris pushes for more sweeping health-care changes — say, bringing back her earlier support for Medicare for All — she’ll cause even worse taxpayer pain.
Tens if not hundreds of millions of Americans would depend on poor-quality, government-run plans, inevitably costing more than expected while discouraging work.
Donald Trump has a superior track record: His first administration created the work requirements that Biden and Harris subsequently eliminated.
While few states had time to fully implement that policy, the experience of Arkansas, which got closest to doing so, shows how beneficial it is.
In roughly 10 months in 2018, Arkansas’ Medicaid-expansion population declined by 40,000 people, who either obtained jobs that offered private coverage or earned too much to qualify.
While the work requirement was suspended during litigation and the pandemic-era public health emergency, Arkansas was on track to save $300 million in its first year, with greater projected savings after that.
If Trump brought back his work requirements in a second term, dozens of states would likely enact them.
He’d also likely push Congress to enact nationwide work requirements, like those proposed in 2023 by House Republicans’ Limit, Save, Grow Act.
That bill, which would restrict the ability of able-bodied adults without young children to access Medicaid, would save $240 billion over the next decade, our analysis found — as people leave Medicaid for productive work and the superior private coverage that usually comes with it.
Taxpayers need the return of Donald Trump’s health-care policies: Under a President Harris, they can only expect a worsening health-care crisis — one that undermines America’s fiscal soundness, economic strength, and the well-being of the very people Medicaid is supposed to help.
Jonathan Bain is a senior research fellow at the Foundation for Government Accountability, where Jonathan Ingram is vice president of policy and research.