NEWT GINGRICH: Want to reform Medicaid? Accountability is the way forward

Thirty years ago, Congress passed major welfare reform based on a clear principle: public programs function best when they reward responsibility rather than dependency. This lesson remains critical for the future of Medicaid. Current structures often create perverse incentives that make waste, fraud, and abuse more common while making effective oversight difficult for state leaders.

Today, Medicaid operates as a massive federal-state partnership, yet states do not always bear the full fiscal consequences of program growth. This creates an environment where political pressure from various groups often outweighs the need for rigorous accountability. When payment models reward high volumes of services without sufficient measurement, exploitation becomes an inevitable outcome. We have seen this clearly in areas like Applied Behavior Analysis therapy, where providers have faced investigations for improper billing and patient mistreatment.

President Trump and CMS Administrator Dr. Mehmet Oz have taken direct action to identify and stop this drain on taxpayer resources. They are launching initiatives across all 50 states to improve provider oversight. However, reform requires more than just investigations. True change requires structural alignment that favors integrity over administrative complacency. States need the flexibility to innovate, but that freedom must be paired with strict accountability for specific results.

Protecting families and taxpayer dollars are not competing goals. Genuine oversight safeguards the reputations of high-quality care providers and ensures that resources reach those who truly need help. Just as the reforms of 1996 shifted the landscape of American welfare, we must now build a system where integrity is the easiest and most natural path for everyone involved. If we apply these same principles to Medicaid, we can secure a more responsible future for our healthcare programs.