Now that H.R. 1 (One Big Beautiful Bill Act) has passed, the unhinging has begun. When I receive or send an email on my county-provided email address, it becomes a matter of public record. So I thought I would share an email I received yesterday…
Much of my work as a County Commissioner is in the Human Services realm. I chair the statewide Works Allocation Committee (WAC), which aids in the distribution of Temporary Assistance for Needy Families (TANF). I sit on the statewide Child Welfare Allocation Committee (CWAC) and the statewide Joint Allocation Committee (JAC), which both have to do with the distribution of available funding.
I represent Colorado Counties on the Colorado Benefit Management System Executive Steering Committee (CBMS ESC – we love us some acronyms). Aptly named, the Colorado Benefit Management System is the computer information system used to determine eligibility and manage the distribution of benefits in our state-managed, county-administered system.
I roll out a few of my “credentials” – my experience in this work – just so I can illustrate that I am familiar with these systems and that I firmly believe in the social safety net. But I also believe it has become bloated, abused, and corrupted. I would be lying if I said that I have read the entirety of HR1 – I haven’t – but I am familiar with the parts pertaining to Medicaid.
In principle, I support work requirements and more frequent redetermination. Pragmatically, in Colorado, these tasks will fall on counties, dramatically increasing our workload and creating an unfunded mandate. President Trump, Weld County cannot afford those mandates. So we must address the workforce issue. I support the intent, but the road to hell is paved with good intentions.
A Little History is in Order
Think of Medicaid as President Lyndon Johnson’s modest safety net—designed to catch only the most fragile among us, not to hoist the entire nation onto the federal payroll. It was born under Title XIX of the Social Security Act on July 30, 1965, with a two-part mission:
- Fill the Medicare holes. Medicare covered seniors; Medicaid picked up low-income kids, pregnant women, the blind, nursing-home residents and the permanently disabled—people who otherwise had nowhere else to turn.
- Share the load with states. The feds wrote the check, the states figured out how to get you into the doctor’s office, the hospital, or a nursing home. No frills—just basic acute-care for people on welfare.
Bottom line: targeted aid, not a blanket guarantee of care.
How It Ballooned Beyond “Basic Safety Net”
Fast-forward sixty years, and Medicaid has quietly morphed into America’s health-coverage catch-all. Here’s the rundown:
- Pregnant women and children: What started as a tiny patch now mandates that states cover pregnant women up to 138% of poverty, and kids at even higher levels.
- Optional extras: Congress gave states free range to insure other low-income adults (think parents, disabled adults). Almost every state said yes.
- Long-term services: Initially, nursing homes and home care were a hodgepodge. Today, Medicaid is the country’s largest payer for those services—a far cry from 1965’s blueprint.
- ACA expansion: The 2010 health law dangled a “90% match” carrot to entice states to cover childless adults up to 138% of poverty. Most states took the bait, swelling rolls and budgets by tens of millions.
Medicaid mission creeped. But there was no creeping. It was a sprint.
Why This Matters
Every new eligibility category or service line:
- Water-downs the original focus. Fewer resources for the very poorest—those Johnson had in mind.
- Shoots up taxpayers’ bills. Federal and state budgets groan under the weight.
- Encourages dependency. When benefits keep expanding, there’s less incentive—or fewer clear steps—to climb back off the rolls. Medicaid was always meant to be a temporary solution, not a permanent fix.
Bottomline
Medicaid began as a lean, mean safety net for America’s most vulnerable. Over time, it’s grown into a sprawling entitlement with no personal-responsibility leash in sight. If we want to get back to the intent, it’s high time to trim back the mission creep and refocus on that original core promise: helping those who literally have nowhere else to turn. I believe that H.R.1 begins to do just that.
But as with all things in politics today…
It’s become a wedge issue used to drive it between us with half-truths on both sides. In candor, democrats believe they can morph the facts (“People will die…”) and use this as a way to claw back power in 2026. But in further candor, the facts are morphed on all sides of an issue. No one seems to be looking for the truth or to solve a problem – all that matters is the narrative in the next election, and it’s shameful.
Let’s work to fix some things. Medicaid is a useful tool and an appropriate program, but it is bloated, abused, and damn near broken. We cannot afford it. It must be retooled, and that comes with cutting the fat. At least H.R.1 tries.
Back to that email…
…from Dr. Aitken. Here’s my response.
