A new Epoch Times poll reveals strong support for reforms to the federal Medicaid program, including work requirements and fraud reduction, while also highlighting deep skepticism about Congress’s ability to implement those changes responsibly.
The survey, which garnered 18,369 responses, comes as lawmakers debate a series of proposals to rein in the federal government’s ballooning Medicaid budget—now exceeding $800 billion a year across both federal and state budgets, including over $600 billion in federal spending alone.
Among the most hotly debated ideas are reducing the federal share of state Medicaid costs, tightening eligibility rules, imposing new work requirements, and capping federal spending per enrollee. These proposals have divided Republican lawmakers, with moderates warning of political backlash from constituents who rely on the program, and fiscal hawks pushing for aggressive cost-cutting to rein in deficit growth.
The Congressional Budget Office has analyzed the projected impact of five potential Medicaid reforms. Depending on which combination is adopted, the federal government could save between $170 billion and $860 billion over the next decade. But those savings would come at a steep cost: as many as 8.6 million people could lose coverage, with nearly 4 million potentially becoming uninsured.
Against this backdrop, the Epoch Times poll offers a snapshot of where readers stand. Through both structured survey responses and more than 10,000 open-ended comments, the results suggest strong support for targeted, accountability-driven reforms—yet caution against sweeping changes that could disrupt care for vulnerable Americans.
Work Requirements, Waste Reduction, and Medicaid’s Expanding Cost Footprint
Medicaid currently covers over 90 million low-income Americans through a joint federal–state partnership. While the federal government provides broad oversight and a significant share of the funding, states administer the program and determine eligibility rules, provider payment rates, and benefit options.
Program costs have surged—particularly since the Affordable Care Act (ACA) expanded eligibility in 2014 to include most low-income adults earning up to 138 percent of the federal poverty level, regardless of parental status. Today, roughly 21 million people are covered through this expansion. For these enrollees, the federal government covers 90 percent of the cost, compared to between 50 and 77 percent for traditional Medicaid recipients, depending on the state.
As a result, federal Medicaid spending has nearly doubled over the past decade, climbing to $614 billion annually. That growth has sparked mounting concern over long-term fiscal sustainability and ballooning deficits.
Survey responses from Epoch Times readers reflect this concern. Nearly three-quarters strongly agreed—and another 12 percent somewhat agreed—that major changes to Medicaid are needed. Only 14 percent expressed opposition or remained neutral, suggesting broad dissatisfaction with the status quo and a strong support for reform.
One reform that has regained momentum is linking Medicaid eligibility to work requirements for able-bodied, non-elderly adults—excluding students and individuals caring for dependents.
During President Donald Trump’s first term, the federal government approved Section 1115 waivers in 13 states that conditioned Medicaid eligibility on meeting work and reporting requirements. Only Arkansas fully enforced the program, which led to over 18,000 enrollees losing coverage before courts intervened.
The Biden administration later withdrew all such waivers, arguing that work requirements undermined the core Medicaid goal of expanding access to care. But as of April 2025, at least 11 states are again seeking federal approval to implement similar policies. Georgia remains the only state with an active work requirement, after successfully challenging the waiver withdrawal in court.
The Epoch Times poll shows overwhelming support for reinstating such policies. When asked whether able-bodied adults who are not elderly, disabled, or caregivers should be required to work at least 20 hours per week to maintain Medicaid eligibility, 86 percent said yes—including 73 percent who strongly agreed. Just 9 percent expressed opposition, and 5 percent were neutral—signaling broad public backing for work as a condition for receiving taxpayer-funded benefits.
Readers consistently identified fraud and waste as top reform priorities. While precise estimates are elusive—since much fraud is undetected—federal reports suggest the problem is substantial. In 2024 alone, the Department of Health and Human Services reported more than $31 billion in improper Medicaid payments, including clerical errors, billing mistakes, and fraudulent claims for services never delivered.
High-profile cases involving hospice fraud, prescription kickbacks, and fabricated treatments have resulted in multimillion-dollar losses and criminal convictions in recent years.
Epoch Times readers appear to see this area as ripe for reform. Rather than reducing coverage or slashing benefits, respondents overwhelmingly favored cutting Medicaid costs by first targeting inefficiency and abuse. In total, 81 percent agreed—including 61 percent who strongly agreed—that the best path to savings lies in reducing fraud and waste, not cutting core benefits. Only 10 percent disagreed.
Trump has echoed this sentiment, repeatedly stating that Medicaid should not be cut—except to root out fraud and exclude illegal immigrants from reaping program benefits.
As Republicans huddle in Washington to hammer out a broad fiscal package that includes Medicaid reforms, Trump’s presence looms large over the negotiations. He has cast himself as both a budget hawk and a staunch defender of core entitlement programs. Regardless of the actions Congress ultimately takes, Trump is determined to improve Medicaid, according to White House deputy press secretary Kush Desai.
“The Trump administration is committed to protecting Medicaid while slashing the waste, fraud, and abuse within the program—reforms that will increase efficiency and improve care for beneficiaries,” Desai told The Epoch Times in an earlier statement.
Rep. Ralph Norman (R-S.C.) is confident congressional Republicans will unify behind a deal, revealing to The Epoch Times the source of his confidence: “Two words: President Trump.” Norman said that once the president starts calling reluctant members, they’ll fall in line.
That view is widely shared by Epoch Times readers. When asked whether Trump’s involvement would help produce a better Medicaid reform outcome, 74 percent said yes—including 51 percent who strongly agreed. Only 11 percent expressed disagreement, underscoring the president’s continued sway over policy debates.
State Flexibility, Fiscal Tradeoffs, and the Future of Medicaid Expansion
While survey respondents expressed broad support for fraud reduction and work requirements, the Epoch Times poll also revealed more nuanced views around federal spending levels and state control. Respondents were split on how far Medicaid reforms should go—and what tradeoffs they would accept.
At the heart of current Republican debate lie two key proposals: reducing the Federal Medical Assistance Percentage (FMAP), which determines how much the federal government reimburses states for Medicaid costs, and imposing per capita caps on federal Medicaid contributions. Both measures are designed to help shrink federal spending by $1.5 trillion over a decade—and shift more financial responsibility to states.
Fiscal conservatives argue these changes would encourage budget discipline and long-term sustainability, while moderates say they could force states to either raise taxes or reduce coverage. This tension was mirrored in the Epoch Times poll.
A solid 65 percent of readers said they favor giving states more authority over how Medicaid is managed—though a sizeable 20 percent were undecided, and 15 percent were opposed to the idea. This suggests broad support for federalism paired with concern about how states would handle the added responsibility.
That divide became more pronounced when the focus shifted to federal spending. While 61 percent of respondents supported reducing Medicaid outlays to address the deficit, 20 percent disagreed and 19 percent were undecided—signaling that enthusiasm for cuts is tempered by uncertainty about potential fallout.
The tension between responsible stewardship of taxpayer funds and providing government-funded health care for the vulnerable is perhaps most pronounced when it comes to the Affordable Care Act’s Medicaid expansion, which extended coverage to more than 21 million low-income adults, many without dependent children. Under this expansion, the federal government offers states a generous 90 percent reimbursement rate, far above the 50–77 percent typical for traditional Medicaid.
Critics argue the higher funding rate unfairly subsidizes able-bodied adults over the truly needy. “It’s necessary to stop robbing from the vulnerable to fund the able-bodied,” Rep. Chip Roy (R-Texas) wrote on X. Supporters counter that ending the higher match rate would lead many states to pull out of the expansion altogether.
The Congressional Budget Office has estimated that lowering the expansion match rate to align with traditional FMAP rules would save the federal government $710 billion over the next decade.
In the Epoch Times poll, 63 percent of readers said they support rolling back the expansion, but 20 percent remained undecided, and 17 percent opposed the move—results that point to the issue’s political sensitivity.
Even among those favoring cuts, many respondents drew red lines around who should be protected. When asked whether Congress should reduce Medicaid spending while preserving coverage for children, pregnant women, and the disabled, two-thirds said yes. Only 16 percent disagreed, suggesting strong public support for reforms that carve out exemptions for the most vulnerable.
The tradeoffs became even more apparent when respondents were asked if cutting federal Medicaid spending should take precedence over preserving current coverage. A narrow majority—56 percent—said yes, but 24 percent were undecided, and 20 percent disagreed.
Gradual Reform, Cost Caps, and a Crisis of Confidence in Congress
Among the more detailed policy questions in the poll were those addressing complex proposals now on the table in Washington, including gradual implementation of reforms, capping federal Medicaid spending per enrollee, and rebalancing the federal-state funding split.
The responses reflected a recurring pattern throughout the survey: while readers strongly favor reform, many are cautious about abrupt changes that risk disrupting care or overwhelming state systems.
On the core question of Medicaid’s role, just over half—51 percent—agreed that the program is essential to ensuring health care access for low-income Americans. But 21 percent disagreed, and 28 percent were undecided, pointing to a lukewarm consensus amid ongoing debate about the scope and purpose of the program.
One of the most debated proposals in Washington is the introduction of per-capita caps—fixed federal spending limits for each Medicaid enrollee, indexed to inflation. Unlike the current open-ended structure, in which federal funding rises in step with state spending, this approach would constrain future federal contributions regardless of state-level cost increases.
According to the Congressional Budget Office, a broad cap applied across all eligibility groups would reduce the federal deficit by over $680 billion within a decade—but would also shrink Medicaid rolls by 5.8 million people and leave nearly 3 million more Americans uninsured by 2034. A narrower version targeting only the ACA expansion population would yield smaller savings of $225 billion and result in 3.3 million losing coverage.
Despite the projected fiscal benefits of per-capita caps, there was relatively weak consensus around the policy among readers. Forty-nine percent agreed that capping federal Medicaid spending per enrollee is a fair way to control costs, including 25 percent who strongly agreed. Meanwhile, 23 percent opposed the idea, and 28 percent were undecided—highlighting significant uncertainty about how such a cap might play out in practice.
Lawmakers have yet to finalize the details of any per capita cap proposal, leaving key questions unanswered. House Speaker Mike Johnson (R-La.) acknowledged the ongoing deliberations on May 8, telling reporters on Capitol Hill, “There’s still ongoing discussion about per capita caps, but it’s a sensitive thing,” hinting at intraparty division. Johnson added that Republicans were exploring a scaled-down version of the plan.
While views on spending caps were mixed, there was broader consensus on how any major changes should be implemented. A clear majority—59 percent—favored a phased rollout of reforms to give states time to adjust, aligning with CBO warnings that abrupt shifts could force states to cut enrollment, reduce provider payments, or eliminate optional benefits.
Still, many respondents were unsure how reduced federal support might impact state finances. When asked whether Medicaid cuts would likely lead to state-level tax hikes, 40 percent said they were uncertain—the largest share of any response category. Another 40 percent believed tax increases were likely, while 20 percent disagreed.
Similar uncertainty surfaced around access to care. Just 31 percent of readers believed that cutting federal contributions would reduce health care access for low-income families, while 33 percent disagreed and 36 percent were unsure—making this one of the most evenly divided questions in the poll.
Asked to rank Medicaid relative to other fiscal priorities such as tax cuts or defense spending, just 23 percent of respondents supported protecting the program even if it meant scaling back elsewhere. A full 56 percent opposed shielding Medicaid from cuts in that context, including 32 percent who strongly disagreed.
Perhaps the clearest message came in response to a question about congressional leadership. Only 19 percent of readers said they trust Congress to manage Medicaid reform responsibly, while 57 percent expressed distrust—including one-third who strongly disagreed. That credibility gap casts doubt on the prospect of real reform in Washington.
Reader Proposals: Cut Fraud, Enforce Work Requirements, Tighten Eligibility
Beyond the structured questions, readers were invited to suggest one change they would make to improve Medicaid. More than 10,000 responded, offering some of the clearest insight into attitudes toward the program.
The most common theme—by a wide margin—was the need to crack down on fraud and abuse. Respondents called for stricter eligibility checks, aggressive auditing of providers, and criminal prosecution of those who exploit the system, whether recipients or medical professionals. Many expressed deep frustration that lax oversight allows billions in taxpayer dollars to be wasted.
Work requirements were also a top concern. Thousands said able-bodied adults should be required to work, train, or perform community service in order to receive benefits. Medicaid was frequently described as a temporary safety net, not a long-term substitute for employment. Several respondents advocated time-limited benefits or scaled coverage reductions for those unwilling to meet basic requirements, especially for childless adults.
Citizenship and immigration status also featured prominently. Many argued that Medicaid should be limited to U.S. citizens or lawful permanent residents, with illegal immigrants categorically excluded. Some called for retroactive audits of enrollment to ensure compliance, citing fairness to taxpayers and concerns about funding priorities.
Other recurring themes included calls to modernize Medicaid’s outdated technology systems, simplify eligibility across states, and bring in private-sector management practices to reduce inefficiency. A vocal minority questioned whether Medicaid should remain a federal program at all, advocating instead for full state control or privatized alternatives.
Overall, readers appear to want Medicaid spending reined in—while leaning towards cautious, disciplined reforms over drastic overhauls.