Tough Fiscal Lessons From My First Year in the Senate

The spending crisis in Washington is dire, and elected officials aren’t doing enough about it. WALL STREET JOURNAL | BY: DAVE MCCORMICK My first year in the U.S. Senate gave me a crash course on how Washington works. It isn’t pretty. I arrived last year worried about the amount of money Congress spends. Our country was more than $35 trillion in debt in 2025 and set to spend another $89 trillion over the next 10 years. Republican control of the White House and Congress this past year presented a rare opportunity to get the country back on track. Tax cuts for working families were a priority. So were spending cuts, including reforms to Medicaid. I went to the numbers: From 2019 to 2024, Medicaid spending jumped 51%, from $409.4 billion to $617.5 billion, now making up 9% of the federal budget. You might assume that increase covered new people getting Medicaid. It didn’t. Enrollment grew by roughly 13%—one-fourth as quickly as spending. Welcome to Washington. In Pennsylvania, spending on Medicaid has soared 80% since 2019 ($30 billion to $54 billion), while the number of Pennsylvanians enrolled in the program plateaued around three million. More than $30 billion is wasted nationwide on improper payments annually, and Minnesota’s $9 billion Medicaid scandal reminds us we have a fraud crisis too. Confronted with these unpleasant truths, my Republican colleagues and I enacted targeted reforms in the Working Families Tax Cuts Act to slow runaway spending while protecting the integrity of Medicaid. To be eligible, able-bodied adults without young kids at home must go to school or job-training classes, work or volunteer 80 hours a month—with clear exemptions for those who can’t work. Spending will grow at the rate of inflation. But as often happens, the most modest of reforms were met with rage and resistance. My Democratic colleagues called them an “unprecedented attack” on healthcare. Think about what’s going on here. We shaved $1 trillion from more than $8 trillion of future Medicaid spending, bringing projected annual growth from about 4.5% to 2.5%. We will still spend nearly $800 billion additional dollars on Medicaid above the current level. We have another overreaction brewing over Affordable Care Act subsidies. Created in 2021, at the height of the pandemic, these temporary expenditures expired last year, but big insurance companies decided to hold working people hostage to try to keep the money flowing. Families in Pennsylvania now face premium increases averaging more than 20%. Some of my colleagues and I are seeking a bipartisan solution to lower premiums for those who need government support, cap payments for high-income recipients, and eliminate fraud and waste. But these common-sense proposals have been met with outright lies and vitriol from Democrats. I want to protect the needy. My paternal grandfather, Pop Pop, was a New Deal Democrat and a county commissioner in Indiana, Pa. Like him, I believe we have a nonnegotiable duty to help the most vulnerable among us. We also have a duty to ensure that our country can meet the commitments that it has promised every American since Pop Pop’s generation. If we don’t do something about runaway spending, Congress will fail the American people. Medicare will start dipping into its reserve money next year. Social Security’s retirement fund will go insolvent in six years, triggering huge and automatic cuts to retirees’ checks. And while the Medicaid reforms reduced the rate of growth, the program continues to grow. On its current course, spending will crowd out other priorities, like national security, as these three programs account for almost half of the federal budget. Against the scale of our fiscal crisis, the fights over Medicaid and ACA reforms look less like decisive battles than skirmishes. But keeping that crisis from spiraling out of control will require incredibly difficult choices: careful spending cuts coupled with revenue-boosting, pro-growth policies. Until I arrived in the Senate, I didn’t appreciate how challenging it would be to get elected leaders to face reality. I am ready to roll up my sleeves to build consensus before we go over the cliff, but the hysteria over modest fiscal changes must stop. When I was a CEO, if I was faced with the prospect of bankruptcy and told my board that I had no plan to scale back spending or change strategy, I would have been fired on the spot. One year into the job as a senator, I’m starting to think that same principle should apply to elected officials. Mr. McCormick, a Republican, is a U.S. senator from Pennsylvania.