Kicking off a new feature – Candidate Questions – First question: Is Medicaid expansion a good idea?

Since 2008, the John Locke Foundation has provided candidates for the General Assembly and state-wide offices research, data and  information to address NC’s most pressing public policy challenges.  Our 2020 Policy Solutions Guide is a much valued and trusted resource. We’ve also held policy briefings, numerous individual and small group discussions and many conversations on the phone and by email. We get a lot of good questions!  So good, in fact, we want to share them more widely here on The Locker Room.  Look for a series of Q &A  – just search “Candidate Question” and feel free to engage in the comment section.

Our first question: Is expanding Medicaid a good idea? 

Answer: No, Medicaid expansion is a bad idea. Here’s why:

• This program was designed for poor children, mothers, the blind, disabled, and the elderly. We should not jeopardize the care that these populations need by expanding the Medicaid program to include able-bodied working-age adults.
• Medicaid expansion lacks any serious health care reform. It does nothing to lower the cost of health care, it just shifts who pays for that health care to the taxpayer.
• Governor Cooper’s Medicaid expansion is estimated to cost $6.3 billion over the first two years. The state would be on the hook for about $630 million in state funds (10%). Governor Cooper and Democrats believe that having the hospitals pay for the state share through a hospital tax makes it free to the state, but this sleight of hand is just a accounting trick to draw down more federal money.
• There are hidden costs to Medicaid expansion as well, such as insurance crowd out and rising private insurance costs.
• North Carolina is not sending our tax dollars to other states to pay for those Medicaid expansion programs. There is no magic pot of money that states pay into and it gets dispersed based on how many states out of 50 have expanded Medicaid. Every dollar that North Carolina sends to Washington is already spent, due to the $1 trillion deficit Congress runs a year.
• Health care coverage does not equal care – enrolling someone in Medicaid does not eliminate the structural problems in the health care system. Our country suffers from physician shortages, hospital shortages, and a general lack of health care literacy. Medicaid expansion will just exacerbate these problems by increasing demand without doing anything for supply.

• With the coming budgetary crisis, expanding Medicaid during the COVID pandemic still a bad idea. It is fiscally irresponsible to raise the eligibility for a massive, open-ended entitlement like Medicaid. We don’t know how much revenue hit we are going to take, and we don’t know how long the revenue hit is going to last.
• Individuals who are uninsured will have their COVID treatment paid for by the federal government. It’s regrettable that Republicans and Democrats in Congress care so little about deficit spending, but they just borrowed $2 trillion to fund the COVID relief packages and it looks like there is going to be more borrowing on the way. Congress has set aside $175 billion for hospitals, and a portion of that is to reimburse hospitals who treat patients with COVID who don’t have insurance. To receive the funds, hospitals have to agree to not to balance bill patients, so in most cases an uninsured will be held harmless.