If you’re that damn busy (I know I am) – here’s the TL,DR summary up top…
Colorado’s Medicaid program has ballooned from a modest safety net into a budget-devouring entitlement monster, covering over 1.2 million residents and eating up a third of the state’s budget. Originally designed to help the truly vulnerable, Medicaid has been bloated by political virtue-signaling and benefit creep, especially after the ACA expansion. As a County Commissioner who deals with this mess firsthand, I believe in helping people when life knocks them down—but not by handing over permanent responsibility to the state. The safety net was never meant to be a hammock, and if lawmakers don’t get serious about reform soon, Colorado’s fiscal cliff is coming fast.
You’ve probably heard the latest shrieking from Colorado liberals—“Children will d-i-e because of Medicaid cuts!”—as if Trump himself is stalking pediatric wards with a scythe. Yes, HR-1 just passed. Yes, it includes Medicaid cuts. And yes, the left is acting like we just strapped kids to the Colorado statehouse steps as a human sacrifice to the Koch Brothers. But before anyone goes full Handmaid’s Tale cosplay in front of the Capitol, let’s pause and unpack this monster.
Let’s start from the beginning—Medicaid was never supposed to be this big. When LBJ birthed it in 1965 alongside Medicare (which helps old folks), Medicaid was meant to help the “deserving poor.” Think: single moms, disabled folks, old people already on their last lung, and children in extreme poverty. It wasn’t some universal free-for-all. It was a cost-sharing deal: the feds paid a chunk, the states paid a chunk, and that was that.
But then the scope creep started.
By the late ’80s, Congress kept expanding it like a stoned frat bro adding toppings at a Chipotle. Pregnant women? Sure. More kids? Why not. Disabled folks who weren’t on SSI? Toss ’em in. Then along came the 1990s and boom—Early and Periodic Screening, Diagnostic, and Treatment services (EPSDT) made it mandatory for Medicaid to cover everything but a shamanic healing ritual for children.
But the real explosion came courtesy of—you guessed it—Obamacare. The ACA in 2010 let states expand Medicaid to anyone making up to 138% of the federal poverty level. That’s about $20k a year for a single adult. Colorado, predictably, dove in like it was an open bar at a DNC fundraiser. The state’s Medicaid rolls ballooned by nearly 400,000 people in a few short years (Colorado Health Institute).
Now Colorado’s Medicaid system—called Health First Colorado because apparently “Free Stuff Now” was taken—covers over 1.2 million people, or one out of every five residents. That’s a hell of a lot of coverage for a state that also wants to fund universal pre-K, green energy subsidies, AND reparations in Denver city limits.
Here’s the kicker: Medicaid isn’t just “federal.” It’s a state-federal hybrid. The feds set baseline requirements, then the states layer on their own goodies. Want to cover acupuncture and adult dental? Go nuts—just don’t expect the feds to foot the bill unless you fill out waivers thicker than a Tolstoy novel.
And Colorado? We’re the overachieving teacher’s pet when it comes to this. We expanded eligibility, added programs for undocumented residents, rolled out dental and behavioral health coverage, and poured billions into “community-based alternatives” to nursing homes—noble on paper, wallet-hemorrhaging in practice.
All of that “generosity” costs money. In 2022, Medicaid spending in Colorado clocked in at over $13 billion. That’s one-third of the entire state budget. And here’s the part that would make any fiscally sane person reach for the bourbon: only 5% of enrollees (mostly disabled and elderly) eat up nearly 40% of the costs. Children might be the poster children—literally—but they’re not where the money’s going.
And can state lawmakers rein it in? Technically yes. They can tinker with eligibility, scale back optional benefits, or slow-walk reimbursements. But the political blowback would make a January 6th hearing look like a yoga retreat. Cutting Medicaid in Colorado is the political equivalent of touching the third rail while chugging kombucha—guaranteed to get you zapped and still smell vaguely of patchouli.
So is Colorado’s Medicaid “out of control”? Depends on your politics. If you think health care is a right, you probably think Colorado is a model of compassion. If you think the government is spending like a Kardashian on a bender, it’s a fiscal abomination wrapped in a virtue signal.
Either way, the next time someone claims “Republicans are killing children” because Medicaid cuts are being proposed, remind them that Medicaid was designed as a targeted safety net—not a universal cradle-to-grave health system for half the damn state. If Colorado wants to turn it into that, fine—but don’t expect D.C. to pick up the tab forever.
My Bottom Line?
Medicaid is a beast, and yeah—it’s complicated. Lucky me, I swim in this muck for a living. As a County Commissioner, I spend a lot of time elbow-deep in Human Services policy, and I work regularly with the folks over at the Department of Health Care Policy and Financing—the agency that runs Health First Colorado, our state’s very own Medicaid megaplex. I’ve seen firsthand how bloated this thing has gotten and how much of it is driven less by real need and more by political theater.
I’m in this work because I do believe in a real, functioning safety net. When life sucker-punches someone—a job loss, a diagnosis, a crisis—we should show up. But that responsibility doesn’t fall solely on the government. It’s on all of us—families, communities, nonprofits, the church. Somewhere along the way, we outsourced compassion to bureaucracy, and now we wonder why it feels so cold and unsustainable.
The problem isn’t the safety net—it’s that we turned it into a hammock. What was meant to catch people temporarily has morphed into a permanent entitlement, and that’s not compassion. That’s policy failure. And it’s not the government’s proper role to carry everyone, forever.
I’ll be breaking down all the juicy (read: horrifying) details in a series of posts over at scottkjames.com/medicaid. I know, I know—what a fun date I must be. Nothing gets the heart racing like budget line items and FMAP percentages, right? But seriously, if you care about where Colorado’s heading, this stuff matters. Medicaid is the single biggest line in the state budget, and the fiscal asteroid is already on a collision course with the Capitol.
The truth is, it didn’t have to be this bad. A lot of the mess we’re in isn’t just about economic forces or demographics—it’s about bad choices. Our state legislature has turned Medicaid into a virtue-signaling playground, layering on benefit after benefit like they’re building the world’s most expensive parfait. But sooner or later, that check comes due. And when it does, we’ll see how much of that virtue signaling was just cosplay, and how much of it can survive the cold steel of a budget knife.
Medicaid started as a modest little program in 1965. Colorado turned it into an Oprah episode: You get coverage! You get coverage! Everybody gets coverage! And now, as costs explode, the idea that someone might pump the brakes is treated like a war crime.
But sure, tell me again how Trump’s a monster for wanting to put a cap on this runaway freight train.
Go on. I’ll wait.
