In an opinion piece for Fox News, former House Speaker Newt Gingrich argues that reforming Medicaid should follow the same principle that underpinned the 1996 welfare reform law: rewarding accountability, responsibility and innovation rather than simply expanding spending. He notes that this year marks the 30th anniversary of the Personal Responsibility and Work Opportunity Reconciliation Act, which he credits with succeeding because it gave states greater flexibility while holding governors directly responsible for outcomes. Gingrich contends the same approach could now fix problems within Medicaid.

The piece is accompanied by comments from Dr Mehmet Oz, administrator of the Centers for Medicare and Medicaid Services, who accused some Democratic-led states of treating Medicaid fraud as a "feature" rather than a flaw, singling out California Governor Gavin Newsom's handling of fraud oversight in his state. Gingrich's argument centres on the idea that granting states more authority over Medicaid must be paired with stronger mechanisms to hold them accountable for results, mirroring the incentive-based model used in the 1990s welfare overhaul.