Op-Ed: Sarah Chamberlain: Dispelling the left’s myth about Medicaid in the "One Big Beautiful Bill"

It’s reconciliation season, which means we’re once again being inundated with exaggerated claims and political scare tactics from the left. One of the most persistent and misleading narratives from Democrats is that President Trump’s “One Big Beautiful Bill” will “gut” Medicaid and strip millions of Americans of their healthcare. That is simply false.

The truth is that our bill reforms Medicaid to make it stronger and more sustainable. After four years of neglect under the Biden administration, the sustainability of Medicaid is at risk. Republicans are committed to fixing Medicaid and protecting the program’s integrity and public trust.

Let’s look at the facts. Medicaid has ballooned into one of the largest and least efficient government programs, covering almost 80 million people, or roughly one in four Americans. Costs are soaring, and oversight has been lacking for years. If we do not address the failures of the previous administration, the program could collapse, putting care for the truly needy at risk.

The “One Big Beautiful Bill” proposes several smart, proven reforms. One of the most important is restoring work requirements for able-bodied adults without dependents, an idea with broad bipartisan support. These requirements are far from onerous, asking only 20 hours per week of work, volunteering, or job training. The bill promotes independence, restores dignity, and helps ensure that the safety net remains strong for those who truly need it.

Another key component is returning healthcare decisions to medical providers, not to unaccountable NGOs or politically connected intermediaries. Doctors, hospitals, and community clinics are on the front lines of care every day. They understand patient needs better than outside groups that often focus more on advocacy and administration than actual outcomes. This reform helps ensure that Medicaid dollars go directly to care delivery, not to overhead, bureaucracy, or activist agendas.

And yes, we must address a reality the media often ignores — millions of illegal immigrants are taking advantage of the healthcare system, including Medicaid, either directly or through fraud. A study by the Federation for American Immigration Reform (FAIR) estimates that taxpayers spend over $18.5 billion annually on healthcare for illegal immigrants. A 2018 report from the Center for Immigration Studies found that 63 percent of non-citizen households’ access at least one welfare program, including Medicaid.

The waste, fraud, and abuse are unsustainable. Americans are compassionate, but compassion without accountability is not a policy. It is a liability. These reforms help ensure that Medicaid serves citizens and legal residents, not those exploiting loopholes or violating immigration laws.

This is about common sense. The “One Big Beautiful Bill” preserves Medicaid for the future by prioritizing the truly vulnerable, eliminating fraud, and protecting the program for years to come. While the left continues to push falsehoods, Main Street Republicans are focused on real solutions. It is time to stop politicizing healthcare and start fixing what is broken using facts, not fear.

Sarah Chamberlain is the President and CEO of the Republican Main Street Partnership, a coalition of almost 100 conservative lawmakers focused on pragmatic, results-oriented governance.