Raining on Medicaid Expansion’s Parade

North Carolina is becoming the 40th state to adopt Medicaid expansion with Republicans putting it over the top like they did in Virginia.  Medicaid expansion is the government health program for childless able-bodied adults making up to 38 percent more than the federal poverty level.  It’s how the Democrats claim so many more people have health insurance than before Obamacare, except Medicaid isn’t insurance – it’s welfare, more free stuff from the government.

Republican lawmakers in North Carolina resisted expansion for years but, apparently, an extra $1.75 billion in federal COVID money on top of the federal government covering most of the costs anyway made expansion irresistible.

Some bad things are going to happen in North Carolina because of Medicaid expansion.  First, it is foreseeable the projected enrollment will far exceed the 600,000 estimate.  In Virginia, for example, expansion advocates promised enrollment would never go over 400,000 but, currently, over 733,000 adults are enrolled.  Before COVID, enrollment in Medicaid expansion was 110 percent over projections nationwide – more than double what was expected.

Second, many states are finding their budgets under significant pressure from unexpectedly high Medicaid expansion costs.  The percentage of the state budget spent on Medicaid goes up and, sometimes, other programs have to be cut.  That’s what happens when you push welfare into the middle class above the poverty line; it gets a lot more expensive.

Third, the hospital lobby in North Carolina called expansion “an immediate shot in the arm” for struggling rural hospitals in the state.  But expansion is not likely to save them.  A recent study concluded:  “Instead of keeping hospitals open, hospitals in expansion states have closed their doors. Instead of creating hospital jobs, thousands of hospital jobs have been cut in expansion states. And instead of saving money, hospital losses are piling up following expansion.”  Medicaid expansion is clearly not the financial salvation supporters make it out to be.

Fourth, Medicaid expansion crowds out care for low-income and disabled children.  Another recent study found “per capita Medicaid spending growth on children in expansion states was less than one-third what it was in nonexpansion states….”  Why?  Because the needs of childless able-bodied adults have been given priority over the needs of such children.

I’ve just scratched the surface.  Other problems with Medicaid expansion include: state tax hikes to fund expansion, less access to healthcare when people move off private insurance and on to Medicaid which has fewer providers, and increasing dependency on government which is always the wrong way to go.

Today, about one in five Americans is on Medicaid.  Some will come off the rolls after extra federal COVID money ends but, as I mentioned earlier, Medicaid expansion enrollment had already ballooned before anyone had ever heard of COVID.  Even so, the day is coming – although it is still far off – when everyone realizes Medicaid expansion was another Democrat – and now Republican – pipedream full of wishful thinking.  It’s clearly not sustainable.  It’s easy to make a political career out of spending other people’s money.  But what will lawmakers posing for congratulatory photo ops today say to people when the parade marches into a ditch tomorrow?

©Christopher Wright. All rights reserved.

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