Colorado Democrats are howling over proposed cuts to Medicaid, showcasing a new report that claims 450,000 Coloradans could lose coverage. They fail to acknowledge how Medicaid expansion reallocates benefits previously preserved for the state’s most vulnerable residents.

U.S. Sen. John Hickenlooper, D-Colorado, said the anticipated reduction to federal Medicaid spending “throws working families under the bus.”

He and other Democrats have long sold Medicaid expansion on compassion. But in Colorado, as across the country, the Affordable Care Act’s (ACA) Medicaid expansion has quietly undermined the people it was meant to protect — struggling single parents, children, and the disabled — to channel resources to able-bodied adults who could fend for themselves but are inclined to vote for politicians promising “free” health care.

Medicaid was already stretched before the ACA dramatically increased demand. A 2010 study in the Journal of Hospital Medicine found Medicaid patients hospitalized for heart attacks or strokes faced higher mortality than those with private insurance. In 2012, Health Affairs reported nearly one-third of physicians nationwide refused new Medicaid patients.

Instead of fixing the system — by increasing funding for the truly needy — Congress and participating states flooded it with 17 million new enrollees. That includes 1.7 million Coloradans since 2014. To buy votes, Democrats dramatically increased demand on the health care system without increasing the supply of care.

Because Medicaid expands demand and ignores supply, the neediest Americans suffer the most as they are forced to compete with adults earning up to 138% of the federal poverty level.

A 2022 Mercatus Center study revealed that Medicaid spending on children grew by just 5.9% per capita in expansion states like Colorado from 2013 to 2019, compared to 22.7% in non-expansion states that protected the program’s focus on the most vulnerable.

Had Colorado rejected expansion, the average child on Medicaid here would have received an extra $504 in care in 2019. Not having it amounts to missed checkups, untreated conditions, and single parents left to navigate a system prioritizing healthy, single adults over their children. Spending growth for the elderly and disabled also lagged, further sidelining those least equipped to provide for themselves.

As expansion enrollment spiked 30% in Colorado, physician acceptance of new Medicaid patients barely budged from 73% to 74%. A 2017 New England Journal of Medicine study noted increased delays in expansion states due to competition for appointments.

Prior to expansion, Medicaid patients were two times less likely than the privately insured to secure appointments. Post-expansion, they are 3.2 times less likely to obtain appointments.

The ripple effects are dire. A 2023 Mercatus study linked expansion to an 11% rise in depression symptoms among pre-expansion Medicaid enrollees, especially in rural Colorado. Emergency rooms face 10% longer wait times post-expansion, as reported by a 2021 Health Services Research analysis — with a 15% uptick in patients leaving untreated. Ambulance response times grew by 24%, based on a 2019 Journal of Health Economics study.

All this because ACA’s enhanced federal match rate for expansion enrollees — 90% versus 50% for traditional enrollees — creates perverse incentives. Colorado and other expansion states have leaned into budget gimmicks to maximize federal dollars, transferring to able-bodied adults that which belonged to children, single parents and the disabled.

With the new demand, expansion nationwide overshot projections by $574 billion from 2014 to 2023, based on data from the Foundation for Government Accountability. Coloradans foot this bill through taxes, while Medicaid’s promise fades for those who have no other options.

Congress and President Donald Trump have a chance to fix this by phasing out the enhanced match rate and refocusing billions on Medicaid’s original mission. Colorado deserves a safety net that prioritizes the truly needy — not a political handout that leaves our most vulnerable fighting for their lives.