Americans should be more worried than ever about Medicaid, which provides health insurance for America’s most vulnerable. A recently released government report found the cost of Medicaid expansion to millions of low-income citizens is increasing faster than expected.

The cost of the $500 billion program is expected to rise to $890 billion by 2024. Yet more spending doesn’t necessarily mean better care for beneficiaries. The expansion of Medicaid is one of the most misguided parts of Obamacare.

It starts with the difficulty patients have getting a physician to see them. Some 55 percent of doctors in major metropolitan areas refuse to take new Medicaid patients, according to a 2014 report.

The same year, the federal government reported 56 percent of Medicaid primary-care doctors and 43 percent of specialists weren’t available to new patients.

Medicaid enrollees who manage to see a doctor typically experience outcomes worse than those under private insurance. That means more in-hospital deaths, more complications from surgery, worse post-treatment survival rates and longer hospital stays than similar patients with private insurance.

Hillary Clinton’s plan for Medicaid is in line with her plans for healthcare reform — expand government programs and entrench the power of the state over private insurance. She would also lower the age for Medicare to 55 from 65, let undocumented immigrants join the taxpayer-subsidized Obamacare exchanges and impose price controls on drugs, among other ideas.

Donald Trump’s campaign says he supports competition among insurers and drug companies through regulatory reform and greater transparency. These are sound principles, albeit without details.

More ambitious reforms can liberate poor Americans from the inferior, low-value health system to which they are shunted. Current federal dollars should establish and seed-fund new Medicaid health-savings accounts, empowering beneficiaries to seek value and create incentives to live healthy lifestyles.

Medicaid reform also ties federal funding to states enrolling more citizens in private insurance.

By changing Medicaid into a bridge to private insurance, Medicaid agencies would help beneficiaries shop for private plans. Doctors and hospitals would receive payments from the same insurance that non-Medicaid patients receive.

Second-class healthcare for the poor would be eliminated, and costs would come down. This should be the goals of any administration’s Medicaid reform.

C. Matt Fariss is the delegate for the 59th Virginia District, which includes Buckingham County. His email address is Delmarfariss@house.virginia.gov.