Sharon Decker, NC Department of Commerce secretary during the McCrory administration in 2013-14, authored this editorial recently published at

Decker attempts to make the case for North Carolina to expand Medicaid, focusing her argument on the potential economic benefits to the state.

She begins her piece, however, with a highly presumptive statement that betrays her ideological tendencies:

We have a health-care problem in North Carolina that brings with it serious economic consequences.

In identifying this problem in a piece advocating for expanding a government program, Decker reveals that she believes this problem is a result of a lack of government intervention in the health care industry. This assumption is absurd on its face, given that close to 90 percent of medical care expenditures are made by third parties, not the patients themselves. This arrangement is produced by massive government interventions like Medicare, Medicaid, and government mandates and regulations that result in nominally private insurance plans covering the majority of expenses. Of course, shielding the consumer from the price of services drives up demand, and as a result costs.

Decker proceeds to tell us the obvious: that healthier workers are more productive because they miss less time. She once again makes an assumption that Medicaid expansion will somehow result in healthier workers. Unfortunately, just like virtually every other expansion advocate, Decker declines to confront the problem that Medicaid coverage does not mean access to care. Stuffing another 600,000 people into an already overcrowded system will result in long wait times, missed check-ups and more desperate people using the wildly expensive ER as their source of treatment.

Decker then declares that an “influx” of between $1.7 billion and $2.4 billion of federal Medicaid dollars will help “boost” our economy. But drawing down these Medicaid funds is contingent on Medicaid being able to provide services to another 600,000 enrollees, something the system does not have the capacity to do. And nevermind the question of where the already $28 trillion in debt federal government will come up with the money. Most likely, it will have to print whatever additional funds NC Medicaid expansion will require, a process that increases wealth inequality and creates price inflation harming low-income households disproportionately.

Moreover, recent research by the Foundation for Government Accountability found that “Over a period of nearly five years, non-expansion states enjoyed annual hospital job growth of 1.55 percent on average, compared to just 1.36 percent for Obamacare expansion states.” Not only was Medicaid expansion not a boon for job growth overall, it couldn’t even help boost hospital jobs.

Decker, like so many others, sees a problem and automatically believes more government is the solution. But what if government intervention is the primary cause of the problem in the first place?