Medicaid expenditures totaled more than $805 billion in 2022, according to new data from the Centers for Medicare and Medicaid Services. That's a 9.6% increase compared with 2021.

The data are the latest indication of just how big Medicaid has become. And that's no accident. For years, progressives have advanced policies that have nudged millions more people onto the program's rolls — to the detriment of taxpayers and the truly needy.

Consider Obamacare, which expanded Medicaid to adults making up to 138% of the federal poverty level, or about $20,000 for an individual in 2023. On average, the 40 states and Washington, D.C., that opted for expansion have enrolled 50% more people and spent about one-third more than originally expected, according to research from the Paragon Health Institute.

During the pandemic, meanwhile, states received extra federal dollars to keep residents — even those who were no longer eligible — continuously enrolled in Medicaid. Enrollment increased by an estimated 23 million people.

States have resumed disenrolling ineligible people. The Biden administration apparently sees that as a policy failure, and it has pleaded with states to go easy on so-called procedural disenrollments, when beneficiaries are removed for administrative reasons but might still be eligible.

Because of policies such as these, more than 90 million people, roughly 1 in 4, were on Medicaid in 2022. Many of them are capable of taking care of themselves or getting individual or employer-based coverage. Some studies, for instance, estimate that up to 43% of new enrollees replace their private coverage with Medicaid.

Ballooning enrollment is straining Medicaid and detracting from its mission to care for the destitute and disabled. In states that have expanded the program, spending on able-bodied and working-age adults is growing at a faster rate than spending on low-income children.

Taxpayers shouldn't be subsidizing care for people who don't need the help. Whether by instituting work requirements or using block grants to cap Medicaid funding for states, policymakers must prioritize sensible reform.

Doing so would help curb Medicaid spending growth — and ensure the program cares for the truly needy patients it was meant to serve.

Sally C. Pipes is president, CEO, and Thomas W. Smith fellow in healthcare policy at the Pacific Research Institute. Her latest book is  False Premise, False Promise: The Disastrous Reality of Medicare for All (Encounter 2020). Follow her on X, formerly known as Twitter, @sallypipes .