Medicaid expanded beyond the population it was meant to serve. Its cost needs scrutiny, too

CalMatters · Jon Fleischman · September 9, 2026

Guest Commentary written by

Jon Fleischman

Jon Fleischman is a longtime California political strategist and writes at SoDoesItMatter.com.

Re: “ Medicaid cuts stand to hit everyone (yes, even you). Here’s why ”

A recent CalMatters story warned that Medi-Cal cuts will raise costs for the privately insured. The reporting was solid, but it skipped the question that actually explains why any of this is happening.

The federal government is $40 trillion in debt and runs annual deficits north of $1.8 trillion. Medicaid has been one of the fastest-growing pieces of that pile for a decade. It has expanded well beyond the population it was built to serve.

Nobody in the story asked what happens if that growth keeps up for another 15 years. The story needed that context and didn’t have it. Part of the reason: Every source quoted has a direct stake in more Medicaid funding, from the hospital association to academics to advocacy groups.

The story’s framing feeds the same growth problem. It treats work requirements as self-evidently harmful because verifying eligibility creates friction. That’s fair. Bureaucracies are blunt. But any means-tested program has to periodically confirm the people receiving benefits still qualify. A safety net that checks nothing indefinitely doesn’t stay targeted at the people it was built for — it just grows.

Closer to home, the pattern is the same: Economists predict the federal cuts will cause a 1% to 2% premium bump, roughly $500 a year for a family. The bigger, more immediate hit is a new state tax on health plans Sacramento just passed , running about $100 a person. Lawmakers did that while everyone watched Washington.

The story also invoked Martin Luther King Jr.- Harbor Hospital’s 2007 closure, which was about patient safety , not funding.

None of this means uninsured and underinsured Californians don’t matter. But you cannot seriously discuss Medicaid spending without asking whether its trajectory is sustainable. At nearly $40 trillion in national debt, that question isn’t optional — for California or for Washington.

Read the full story at CalMatters