Gov. Josh Shapiro isn’t pleased with the recent passage of the One Big Beautiful Bill (OBBB).

“Pennsylvania got screwed,” he recently told a crowd in York, Pa., citing his concerns about how the bill “slashed Medicaid.”

Contrary to the governor’s claim, Medicaid will still grow. Undoubtedly, the program’s baseline will shrink when OBBB goes into effect. However, the Congressional Budget Office found that federal Medicaid spending will still grow by 50 percent over the next decade.

Only in the world of politics can a multibillion-dollar spending increase be called “a cut.”

Unfortunately, that’s just one of the many myths about reforming Medicaid, so let’s address a few others.

Medicaid is a huge expense for Pennsylvania. Pennsylvania’s Independent Fiscal Office projects total Medicaid spending to reach $54 billion in fiscal year 2025–26, about one-third of general fund spending. Plus, for the past six years, Medicaid spending has increased by eight percent annually and is projected to rise by nine percent next year.

Considering that the commonwealth’s projected revenue will grow by only one percent next year, the long-term expense of Medicaid is unsustainable. Pennsylvania cannot afford not to address Medicaid.

Federal prosecutors recently filed charges against a Pennsylvania woman for nearly $1.1 million in fraudulent Medicaid reimbursements.

Sadly, that isn’t an isolated incident.

Over the last decade, the federal government paid as high as $1.1 trillion in improper Medicaid payments. In Pennsylvania, improper payments totaled $2.3 billion. Recently, the Pennsylvania Auditor General found incorrect payments in 12 percent of the audited cases.

Given Medicaid’s already large budget and the sizable waiting list for services for the state’s disabled population, Pennsylvania should take action to address waste, fraud, and abuse.

Experience shows that work requirements return adults to work. Arkansas became the first state to require part-time work for able-bodied, childless adults on Medicaid in 2018.

The Arkansas law required enrollees ages 19–49 to perform 80 hours of work or other qualifying activities (e.g., job training, community service) per month. That works out to 960 hours per year—about five percent of a full-time equivalent. The OBBB work requirements are even less strenuous, requiring 80 hours for at least one in every three months.

Respectfully, Medicaid work requirements are a low hurdle to jump.

Importantly, Arkansas’s plan worked—quite literally. According to state-level data, more than 9,200 Medicaid enrollees gained employment after the work requirements went into effect. Plus, more than 14,000 Arkansans left the program because their income levels increased.

In the end, Medicaid recipients will become more financially independent and less reliant on government subsidies.

Some reform opponents argue that work requirements are unnecessary because most healthy, able-bodied enrollees already have jobs. However, this claim is based on self-reported data, which is far from reliable. For example, a 2022 survey found that 30 percent of Medicaid enrollees mistakenly reported that they weren’t enrolled in Medicaid.

Meanwhile, state-level data tends to be more reliable.  Today, Pennsylvania enrolls about 800,000 working-age adults in Medicaid. The Pennsylvania Department of Human Services found that about half of this group is employed.

In 2018, two-thirds of Pennsylvanians supported work requirements for working-age, able-bodied Medicaid enrollees without dependents. Seven years later, that robust majority grew to 84 percent.

And this sentiment isn’t limited to the Keystone State. A separate national poll found the exact same percentage of support.

Increased Medicaid spending certainly hasn’t stopped or slowed the alarming rate of statewide hospital closures.

Pennsylvania expanded its Medicaid program in 2015. Since then, dozens of hospitals have closed statewide.

And this closure rate has gained momentum in recent years. The Pennsylvania Health Access Network researched 20 years’ worth of data on hospital closures and found that nearly half occurred in the last five years.

Medicaid pays significantly less than private insurance for the same medical care. In Pennsylvania, Medicaid paid hospitals 82 cents on the dollar of what private insurance paid per day for inpatient care. That reimbursement rate is even lower in rural communities: about 74 cents on the dollar. Work requirements that result in more Pennsylvanians working with access to private insurance are far better for rural hospitals than expanding the number of patients reliant on an underpaying government program.

Medicaid is a broken system long overdue for reform. Work requirements to help healthy adults regain their independence are the first step to ensure Medicaid’s long-term sustainability. Ultimately, Pennsylvanians will need to do much more to rein in wasteful spending, such as conducting more robust government data cross-checks to ensure eligibility and refusing to contract with unscrupulous providers. We can do more to protect Medicaid for low-income kids, pregnant moms, seniors, and the disabled.

We cannot allow misinformation to hinder the reforms necessary to save Medicaid.