Few components of America’s healthcare system are more in need of reform than Medicaid, the joint federal-state public health plan for low-income Americans. And with Republicans set to control the House, Senate, and executive branch next year, there’s finally a chance to address the program’s considerable problems.

The most serious is cost. In 2023 alone, total spending on Medicaid exceeded $880 billion. That’s up from $806 billion the year before, an increase of more than 9%.

In 2023, Medicaid and the related Children’s Health Insurance Program together accounted for $1 out of every $10 spent by the federal government. The program is an even bigger expense for states, representing 18% of all state spending.

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