The comprehensive legislation, dubbed by some the “Big Beautiful Bill” (BBB), includes a substantial set of provisions pertaining to healthcare. These proposals aim to reform Medicaid, Medicare, the Affordable Care Act (ACA), and other health-related sectors. However, rather than offering genuine solutions, these healthcare sections largely entrench and expand failed federal programs. Market-based and state-level solutions are the appropriate path forward; continuing with the current trajectory will only worsen our $37 trillion national debt and further degrade our healthcare system.

Medicaid and CHIP: Entrenching a Failed System

A significant portion of the bill addresses Medicaid and the Children’s Health Insurance Program (CHIP), programs that have demonstrably failed to deliver efficient, fiscally responsible healthcare.

• Enrollment and Eligibility: Provisions imposing moratoriums on recent rules for Medicaid/CHIP enrollment (Sec. 44101, 44102), while citing concerns over states’ ability to remove ineligible enrollees, tinker at the edges of a fundamentally broken system. Robust income verification, streamlined through tax data, is essential, but this addresses symptoms, not the core disease of these programs. The argument that the delayed rules could weaken verification standards only underscores the inherent vulnerability to fraud and improper payments within these federal structures.
• The mandate for states to improve enrollee address information and participate in a federal system to prevent multi-state enrollment by 2029 (Sec. 44103) is a minor, albeit logical, measure within a system that requires wholesale replacement.
• Quarterly screenings against the Death Master File (Sec. 44104) and enhanced provider screening (Sec. 44105, 44106) are basic anti-fraud measures that should have been rigorously implemented decades ago, and their inclusion now highlights past failures.
• Increasing eligibility redeterminations to every six months (Sec. 44108) will inevitably create more bureaucracy, not genuine integrity, within these failed expansion programs. Stringent initial enrollment criteria are necessary, but the programs themselves are the problem.
• Proposed revisions to home equity limits for Medicaid long-term care (Sec. 44109) are an egregious component of a system that forces asset depletion. The link between Medicaid and long-term care services must be severed entirely.
• Prohibiting Federal Financial Participation (FFP) for individuals without verified immigration status (Sec. 44110) is a necessary, though insufficient, step toward fiscal discipline.
• Conversely, efforts to “streamline” enrollment for out-of-state providers (Sec. 44302) are a pathway to inefficient contracting and cronyism, typical of bloated federal programs.

• Spending and Program Integrity:
• The removal of the good faith waiver for certain erroneous excess Medicaid payments (Sec. 44107) is an admission of the rampant improper payments that plague the system, reinforcing the argument that Medicaid must be abolished.
• Modifying retroactive Medicaid/CHIP coverage (Sec. 44122) is a trivial adjustment.
• Federal intervention in pharmacy payments (Sec. 44123, 44124) is an unacceptable overreach. Free markets, not government dictates, ensure fair pharmacy pricing.
• The prohibition of federal Medicaid/CHIP funding for gender transition procedures (Sec. 44125, Sec. 112030) is correct; such funding has no place at the federal level and should be entirely a private matter, with no exceptions for federal dollars.
• Prohibiting federal payments to “prohibited entities” in family planning (Sec. 44126) is a sound policy; such funding decisions should be eliminated from public coffers altogether.
• Sunsetting increased FMAP for new Medicaid expansion states (Sec. 44131) and imposing a moratorium on new provider taxes (Sec. 44132) are welcome, as no new taxes should support these failing programs.
• Revising payments for state-directed Medicaid based on Medicare rates (Sec. 44133) perpetuates federal price-fixing. Medicaid must be dismantled, replaced by a system focused on transparently priced emergency and preventative services, potentially leveraging innovations like robotic-assisted procedures to reduce costs and liability.
• Mandating Medicaid community engagement requirements (Sec. 44141) is a gross federal intrusion into matters that are exclusively state or local concerns.
• Modifying cost-sharing for Medicaid expansion individuals (Sec. 44142) is merely propping up a failed expansion of a failed program using flawed metrics like the federal poverty line. The entire edifice needs to be replaced with free-market solutions.