The program delivers the biggest benefits to the richest states. It’s time for broader reform.

Over the past few months, Democrats have hammered Republican health care reform proposals as dangerous and devastating for the poor. Sen. Elizabeth Warren exclaimed, “These cuts are blood money. People will die,” while others have suggested that they are the “real death panels.” These attacks have only the loosest relationship with the facts, but Democrats have a point when they argue that the GOP’s Medicaid reforms don’t simply reinstitute the pre-Obamacare status quo.

Critics frame this as a bad thing and warn that the changes “would end Medicaid as we know it.” But Medicaid has already changed greatly from its authors’ original design. While often failing to secure essential services for the neediest beneficiaries in the poorest states, the program allocates a disproportionate and ever-increasing amount of money to the richest states, whose representatives now boast of it as a “middle-class program.” The program’s lopsided growth has left it poorly focused on its core mission—and needing reform to get back on track.

Enacted along with Medicare in 1965, Medicaid was designed by a moderate Southern Democrat, Rep. Wilbur Mills (D-Ark.), to help states fund essential medical services for individuals on welfare who could not be expected to work for reasons of age, disability, or family responsibilities. Over the past half-century, able-bodied adults have increasingly been made eligible and the array of services covered under the program greatly expanded. As a result, enrollment has increased from 22 million in 1975 to 69 million in 2017, while total spending has soared from $16 billion in 1975 to $545 billion in 2015.

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This article  is republished with permission from our friends at the Manhattan Institute for Policy Research.