Medicaid’s Ghost Networks Are Failing Families

Originally published on Substack. 

​Another week, another blockbuster story showing why America keeps paying more for “coverage” while getting less actual healthcare. The Wall Street Journal just dropped a devastating investigation into Medicaid’s provider “networks” — and it’s exactly the kind of systemic failure you’d expect when government tries to centrally manage a $900 billion program through giant insurers who get paid whether patients receive care or not.

The headline says it all: Medicaid insurers promise lots of doctors. Good luck seeing one.

This isn’t a glitch. It’s the inevitable result of a government-run system built on incentives that reward paperwork, not healing.

Let’s walk through what’s happening — and why it’s yet another reminder that coverage ≠ care.

​A System That Pretends to Work, Until You Actually Need It

The Journal found something stunning but not surprising: More than one-third of doctors listed in Medicaid networks never saw a single Medicaid patient last year. In psychiatry and other key specialties, almost half saw zero. That’s not a network. That’s a ghost town with a phone directory.

And behind every one of those ghosts is a real family left waiting, pleading, or driving 90 miles for care that should be accessible in their community.

A few examples that hit hard:

• A mother in Illinois desperately searching for a child psychiatrist after her son repeatedly ran away — placed on a 12–18 month waitlist despite dozens of “in-network” options.
• A man in Texas told by every rheumatologist in his plan that they aren’t accepting Medicaid patients. His fallback advice? “Don’t get sick.”
• A baby in East Texas with a rare neurological disorder — forced to travel to Dallas, only to miss the appointment when Medicaid’s ride-share system failed.

This is not a safety net. It’s a web of bureaucratic illusions.

Why This Happens: Bad Incentives, Bad Data, Big Gatekeepers
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Here’s the uncomfortable truth: Medicaid pays providers far less than private insurance.

That means many specialists have to choose between treating a patient at a loss or keeping their doors open. So they do the rational thing under a distorted system: They limit Medicaid slots, or stop taking Medicaid altogether.

Meanwhile:

• Insurers get paid by the state whether patients are seen or not.
• States rely on insurer-reported networks rather than outcomes.
• Directories are filled with misidentified, out-of-state, retired, or long-gone doctors.
• Federal rules focus on maintaining “adequate networks,” not on actual access.

​That’s how you end up with South Carolina counties supposedly full of neurologists who live in Florida, or Texas networks that list nurse practitioners as psychiatrists.

Central planning strikes again!

Coverage Isn’t Care — and It Never Has Been

Medicaid enrollment has exploded in the last decade. Costs have surged. Insurer revenues have soared into the tens of billions.

But none of that magically increases the number of specialists. None of it shrinks waitlists. None of it fixes workforce shortages created by regulations, licensing bottlenecks, scope-of-practice restrictions, and reimbursement ceilings so low that many clinics simply cannot survive.

The result?

A massive program where patients technically have coverage, but practically have access to… nothing. And politicians still pat themselves on the back for “expanding” it.

The Human Cost: Delays, Desperation, and Declining Health

We’re not talking about mild inconveniences. These failures hit the most vulnerable:

• Kids with autism who need psychiatric care now, not in 18 months.
• Patients with fungal meningitis seen by primary-care doctors because specialists are booked until 2027.
• Families forced to choose between a 2-hour drive or no care at all.

When government coverage crowds out private coverage and overwhelms clinics, the people who should benefit most end up at the back of the line. And the tragedy is predictable — because Medicaid is designed to expand enrollment, not solve underlying supply shortages.

We Need a Healthcare System Built on Voluntary Exchange, Not Bureaucratic Promises

If you take one insight from the Journal’s reporting, let it be this: A system based on inaccurate networks, bureaucratic contracts, and centrally dictated prices can’t possibly deliver timely, high-quality care.

People need choices. Doctors need flexibility. Patients need direct access. Markets need freedom to innovate, compete, and meet demand.

We don’t need more “coverage.” We need more care — delivered through a system where providers are rewarded for serving patients, not gaming directories. The big insurers play the government’s game because the money is too good. Families play by the rules and still lose. It’s time to flip the incentives.

The Path Forward

Real reform starts with simple principles:

• Pay directly for care, not intermediaries.
• Remove the regulatory bottlenecks that restrict supply.
• Empower patients with portable dollars in no-limit HSAs and transparent market prices.
• Encourage innovative delivery models outside bureaucratic control.

Healthcare flourishes when people exchange value freely — not when states procure care like they’re buying office supplies. The Journal exposed the façade. Now policymakers need the courage to build something real.
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Don’t miss the WSJ article where you can find the charts above and more stories:

Medicaid Insurers Promise Lots of Doctors—Good Luck Seeing One: https://www.wsj.com/health/healthcare/medicaid-insurers-doctor-networks-appointments-72f9c11f

More soon. Stay well — and let’s keep fighting for a system that actually lets people prosper.