President Donald Trump, Elon Musk, and other leading Republicans have pledged to slash government waste, fraud, and abuse. But despite all the media handwringing and protests, the actual numbers are minuscule. Trump and the GOP have barely scratched the surface. Meanwhile, the national debt continues to careen toward $37 trillion.

Federal entitlements such as Medicaid make up a significant portion of that debt.

Medicaid is “the fast-growing entitlement that now spends more than $850 billion a year while delivering subpar healthcare for the poor,” explains the editorial board at The Wall Street Journal. “The left and the press are trying to intimidate the GOP from addressing the program’s failures, and President Trump is already having doubts. But Republicans can win the Medicaid argument if they understand how the program has gone wrong, and make their case in the moral terms it deserves.”

Any party serious about reducing the debt must reform entitlements, but it’s easier said than done. Democrats and their media sycophants have the upper hand. They denounce any hint of government reform in the most extreme ways, and they’ve convinced Americans for decades that Republicans hate the poor.

Republicans, for their part, have kept their distance from Medicaid reform when they’ve been in power. And President Trump has repeated his promise to leave Social Security alone so many times that it’s astounding anyone is still afraid he’ll take their benefits. He isn’t likely to open himself up to criticism for touching Medicaid. In an interview with Fox News’s Sean Hannity, Trump said he won’t touch that either.

But Medicaid is fraught with abuse and, thanks to ObamaCare, its burden on the federal government is substantial. As a first step, Republicans need clear messaging to change the public’s perception about what Medicaid is meant to do and how it has changed. The Wall Street Journal adds, “Voters tend to think of Medicaid as a safety net for low-income pregnant women and disabled Americans. But Barack Obama’s Affordable Care Act expanded the program into a permanent entitlement for childless men in prime working age.”

Democrats are perfectly fine with young working men receiving benefits from Medicaid. But it’s not good for otherwise healthy adults to sit at home and cash a federal check. It’s not good for our country, either in societal or economic terms, as it drives up the cost of Medicaid and takes services away from those who genuinely need them.

“Medicaid enrollment and costs have skyrocketed this century,” according to a report by the Foundation for Government Accountability. “The biggest driver of this growth is the increase of able-bodied adults in the program, burdening taxpayers and the truly needy alike. In total, nearly 85 percent of the enrollment increase over the last 10 years is directly attributable to able-bodied adults. Enrollment of able-bodied adults has crowded out resources for the truly needy, including seniors, children, and individuals with disabilities.”

The FGA also states, “Medicaid costs have exploded, reaching nearly $919 billion per year, up from $206 billion in 2000. Federal taxpayers have borne the brunt of this growth, with federal Medicaid spending increasing more than fivefold over this period. Without reform, the burden on federal taxpayers will only continue to climb, with the program’s expected costs to top $8.6 trillion over the next decade.”

Most Americans aren’t getting this information and, for the most part, think any attempt at reform means taking away benefits from those who need them.

Despite fraud and abuse in the program, Axios reports that a new poll conducted by McLaughlin & Associates finds “overwhelming majorities of voters in battleground congressional districts support the Medicaid program, including 78% of Trump supporters.” Medicaid provides medical benefits to nearly 80 million Americans, so Republicans will need to thread the political needle and make sure any changes aren’t viewed as a threat to legitimate Medicaid recipients.

One approach being considered is to ask states to contribute a slightly higher percentage toward the program’s costs. “Currently, states that have enacted Medicaid expansion under the Affordable Care Act receive a 90 percent federal matching rate, known as the Federal Medical Assistance Percentage (FMAP),” Newsweek reports. “This means the federal government takes on 90 percent of those costs, while the state governments take on 10 percent.” GOP Representative Austin Scott of Georgia proposes reducing the federal government’s FMAP percentage to help reduce the national debt.

Another approach being considered by both Republicans in Congress and several states is to require able-bodied recipients to work and for those who are working to prove they are employed. States must seek federal approval for such requirements, which the Biden administration axed but are now back on the table.

According to a recent poll by the Kaiser Family Foundation, nearly half of Democrat voters approve of work requirements, along with 82% of Republicans. Overall, 62% support asking recipients to work, but KFF admits in its poll that “public opinion on both proposals is malleable when people hear arguments or are given more information.”

Reducing our national debt will require difficult decisions and courageous political action, and changing the public image of the federal government as our national caretaker will be even harder.

For now, Republicans should focus their message on making sure Americans understand that eliminating fraud and abuse, asking states to carry more of the burden, and requiring work will not only make the program less costly and more efficient but also enable it to help those who truly need it.