- State Senate budget leaders laid out the case against Medicaid expansion
- Expanding the state’s Medicaid program would be a band-aid on the larger healthcare access problem and would likely make access problems worse.
- Contrary to the Left’s narrative of racism or bias, there are many legitimate reasons conservatives oppose expanding Medicaid to able-bodied adults.
Negotiations on the state budget got heated this week, with Senate budget committee chairs accusing Gov. Roy Cooper’s staff of threatening to walk away from any deal that does not contain an expansion of the state’s Medicaid program.
Authorized under the Affordable Care Act, Medicaid expansion allows any low-income individual to qualify for the government health insurance program, regardless of other factors that are currently used to determine need (e.g. having a disability, or being a child, parent, elderly person, or pregnant woman).
Senate budget leaders responded to Cooper’s demands in a letter, in which they clearly outlined their opposition to expanding Medicaid. They gave a concise argument and hit the nail on the head.
- “No guarantee of continued federal funding, which could put North Carolina taxpayers on the hook for billions of dollars (e.g. NC Health Choice).” The federal government pays 90 percent of the costs for individuals newly eligible under expansion; it pays around 67 percent for current Medicaid recipients. It is very likely that the higher federal match will not be a permanent rate, and it would be nearly impossible (politically, logistically) to end expansion if the match decreases. This could leave the state with a giant Medicaid funding hole – and it wouldn’t be the first time. A higher federal match for another program was recently reduced, leaving the state to fill a $141 million hole. Policymakers are wise to be cautious of this when you consider that Medicaid, as an entitlement program, has to be funded before the state can spend any money on education or public safety. Expansion proponents say that this is no reason to object to expansion since we rely on other federal programs that could also be de-funded in the future. This should lead legislators to reconsider the wisdom of relying so heavily on a federal government that is $22 trillion in debt, but does not justify doing so even more.
- “Medicaid expansion puts able-bodied, working-age adults ahead of those with intellectual and developmental disabilities.” This refers to the state’s “innovation waivers,” a product of Medicaid that funds special services for individuals with intellectual and developmental disabilities. Unlike traditional Medicaid, the waivers are not fully funded – meaning that not everyone who is eligible is able to get services. Expansion threatens this population because the state already isn’t fully funding them – a problem that could be made worse if the state has to start filling expansion funding holes. Many claim expansion will cost state taxpayers no money, due to a raised hospital tax built into the proposals. First, this is based on the faulty logic that a new tax being added doesn’t count as a tax increase because it’s targeted to a specific industry. Second, most expansion states have overrun their projected costs and enrollments, meaning the tax revenue may not be enough to cover the cost. Not to mention the very likely possibility discussed in the first point. Budgets are about tradeoffs and priorities, and expansion puts mandatory spending for able-bodied adults ahead of fully funding the commitment the state has made to individuals with disabilities.
- “Expansion will force the traditional Medicaid population (children, expecting mothers, the elderly) to compete with able-bodied, working age adults for access to limited doctors.” Health insurance coverage does not equal access to care. Due to lower provider reimbursement rates, many current Medicaid recipients already struggle to find a doctor to accept their insurance. Adding an additional half million people to an already overcrowded system will exacerbate that problem, worsening access for those who need it most.
- “Medicaid expansion will not solve the rural health access crisis because there are already too few doctors to care for people in those communities.” Rural healthcare access is a real concern, but Medicaid expansion will not solve that problem. Proponents claim that doctors will rise up to meet the expanded need, but lower reimbursement rates for Medicaid show this is not founded in reality. While some new Medicaid recipients will have been previously uninsured, others will be forced off their private individual plans, actually harming providers. In poor rural areas, healthcare providers will be able to turn away additional Medicaid patients, leaving those individuals no choice but to utilize rural hospitals, who are forced to take everyone. Once those hospitals reach a critical mass of their patients on coverage with lower reimbursements, they will be forced to shift costs to the privately insured or even close their doors.
The mainstream media ignores the clearly laid out objections to expansion. Instead they blame “racism” and “lack of empathy” for Republican leaders’ unwillingness to expand. Progressive responses to these four points did little more than spout rhetoric with no facts to back it up. While the Senate leaders are doing an excellent job standing firm on this issue, there are several more reasons to oppose Medicaid expansion:
- Government involvement in the healthcare markets drive up costs for everyone; more government intervention cannot possibly be the solution. Patient-centered, market based reforms that peel back government restriction open the market up for competition, and drive down prices for everyone.
- Reliance on more federal funding is immoral considering the nation’s debt will have to be paid by future generations.
- The current system has its share of fraud and waste that still needs to be addressed.
- Given that 78 percent of the expansion population would be childless adults, and even working full time at minimum wage would push their income too high to qualify for expansion, the coverage gap is more of a workforce problem than it is a healthcare problem.
During a time of economic prosperity, Cooper and his progressive allies lack a case for the expansion of the welfare state in North Carolina. Considering the legitimate concerns against expansion, this seems to be about claiming a political win by putting a band-aid on a problem, instead of working to increase access to affordable care for the state in the long run.