The Truth About Medicare, Medicaid & Where the Money Really Goes

Dr. Jessica Edwards is a board-certified family medicine physician and health policy expert, as well as the founder of Zahra Medical, a hybrid care platform focused on accessibility and affordability. With real-world experience in both medicine and motherhood, and deep insight into U.S. health policy, Dr. Edwards is a trusted authority for demystifying complex healthcare topics—especially when it comes to public funding, pharmaceutical influence, and social equity.

In this myth-busting episode of The Humanity of Fame, host Kali and Dr. Jessica Edwards break down what people think they know about Medicare and Medicaid—and what’s actually true. From misunderstood budget cuts to the eye-opening fact that 30% of Medicare’s budget goes to pharmaceutical costs, this conversation exposes the lobbying, legislation, and miscommunication that shapes national healthcare conversations.

Dr. Edwards also highlights how most of Medicaid’s spending doesn’t even go to who people think it does—with large chunks allocated to end-of-life care and neonatal intensive care for sick babies. She discusses how misinformation affects voting, how policies harm the most vulnerable (including pregnant women in states like Texas), and how oversimplified narratives allow devastating decisions to pass under the radar.

Key Takeaways:

• 30% of Medicare’s budget goes to pharmaceuticals, mostly due to legislation that prevented price negotiation
• Only about 50% of Medicaid funding supports women and children—the rest is heavily weighted toward nursing homes and neonatal care
• State efforts to cut Medicaid often ignore their own reliance on federal funding
• Misleading headlines lump all funding together, leaving voters unaware of the human cost of budget cuts
• In states like Texas, women often can’t access Medicaid until 20 weeks into pregnancy, missing critical early screening and care

Guest Contact:
🌐 ZahraMedical.com
📣 Follow Dr. Edwards for fact-based, no-fluff commentary on U.S. healthcare reform, patient advocacy, and public health education.

Find out more about Kali and the show HERE: https://humanityoffame.com/

Transcript

0:00

I also like to debunk a lot of myths about where the funding actually goes for Medicare and Medicaid, right? Because if you think about a lot of the Medicare budget, 30% of it is pharmaceutical cost. Pharmaceutical costs, 10 drugs make up a vast majority of that. Because up until a couple of years ago, there was literally legislation passed. Lobbyists really affect a lot, and that's all I'm saying. But there was legislation passed that Medicare was unable to negotiate prices for drug companies. But how much of the budget is based on pharmaceuticals? 30%. So the math don't math, but you follow the money, and you follow the drug, you see the donations, you see the visits, you see, and it all comes out. And so when you look at even Medicaid, you know, it ran by the states. A lot of the states that are getting ready to pass legislation to eliminate Medicaid actually really depend on the federal government for that, which is intuitive, but you just don't. Only like 50% of Medicaid actually goes to women and children. 25 to 35, 40% actually goes to end of life care for those who are in nursing homes. Whoa. But nobody's breaking it down. Everybody's just Medicare, Medicare, Medicaid, Medicare. Yeah, yeah. But nobody's looking at that because we're just doing stuff and people are pay to play. And I'm smiling because I'm just like, it's so much. You wouldn't even think that because a lot of the NICU stays for babies that are sick, a lot of that budget. Sometimes it's preventable. Sometimes it's, it's, you know, women who aren't able to get access to care. I remember I was reading a article a couple of months ago, or I think I was, maybe it was a year or two ago, I was preparing for a presentation. I'm talking about maternal morbidity, mortality. And in Texas, most women don't even get access to Medicaid until they're 20 weeks because of how cumbersome the process is. So you're not screening women until they're five months pregnant and they're delivering at nine months. Yeah. A lot, a lot happens in that first trimester. A lot. Yeah. A lot of screening can also happen in that first trimester. So, you know, I, I think a lot of the, the moves that we're making as a country, particularly when it relates to healthcare, counterintuitive, that's my personal opinion, you know, but I think it negatively affects all of us. And I think a lot of us don't even know the things that we are voting to eliminate because we don't know. Nobody's like breaking down, like this is what the cost is. I guarantee if you tell people, Hey, we're going to cut Medicaid and you know, 75% of this is going to be for, you know, elderly people and babies who need support in the first, you know, maybe a couple of days, weeks, a month. I guarantee you people wouldn't vote for that. Right. But when you just put everything under one umbrella, it's easy. Oh yeah. Eliminate that.