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Medicare is an emotionally charged program because it provides health insurance coverage for the elderly. But Medicaid covers America’s poor and disabled—and no one wants to see them harmed, either.

However, like Medicare, Medicaid is also in desperate need of reform if it is to continue serving the people it was designed to serve. Nearly one-third of America’s doctors are already opting out of treating Medicaid patients—because their costs often outweigh what the program pays for care.

States—which already have budget crises of their own—share the cost of Medicaid with the federal government. They can’t afford to simply add more people to Medicaid, which is one of Obamacare’s main ways to insure more people. (The Supreme Court’s Obamacare decision gave states some breathing room when it ruled that Obamacare’s Medicaid expansion must be optional for states.)

The program already covers 62.5 million people—about 20 percent of America’s population—and federal spending on Medicaid has no limit. That’s right—there are no limits on federal spending for Medicaid. But there are limits on American taxpayers’ wallets.

Simply adding people to Medicaid should not be the goal. Instead, like other welfare reforms, the goal should be helping people while they’re down—and helping them get back up.

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