by Donna Martinez
Former Senior Writer and Editor, John Locke Foundation
North Carolina lawmakers have wisely resisted pressure from the Left to add more than half a million people to the government’s Medicaid program. Locke’s Jordan Roberts has extensively chronicled the many reasons why this is a costly and poor approach to expanding access to care, while Locke’s Brian Balfour has written about the disturbing lack of oversight in the Medicaid program.
Roberts’ analysis has now been picked up by National Review. He writes:
Ever since the passage of the Affordable Care Act allowed for states to add able-bodied adults up to 138 percent of the federal poverty level to Medicaid programs, such organizations as the John Locke Foundation — where I work on health-care policy and other free-market initiatives — have repeatedly argued that expanding Medicaid is the wrong policy prescription for North Carolina.
This time around is different from previous budget fights, however, because the Biden administration has signaled its intent to bypass states that have thus far fought the federal government’s encroachment. Congress’s hotly debated $3.5 trillion reconciliation bill contains a provision that would end-run non-expansion states to cover the population who would otherwise be covered had their state opted for expansion.
Although Congress has yet to pass the bill, this new development has led some in North Carolina to question whether the time has come to expand Medicaid as offered by Obamacare. One cannot ignore the systemic issues that plague our health-care system and leave some without access to care. But despite these shortfalls, policy-makers need to look for private market solutions — such as alternative coverage plans and supply-side reforms — rather than doubling down on government-run health programs.
Roberts reminds us that “coverage does not equal care.” So how should we address a very real problem of access?
Lawmakers need to focus on reforms that expand the supply of health care in our state and in others. Thankfully, there are three simple reforms that can boost the health-care supply in North Carolina, resulting in downward pressure on prices and increased access. First, substantially reform certificate-of-need laws that have shown through decades of research to limit supply and drive up health-care costs. Second, expand full practice authority to highly trained advanced-practice nurses in the state, so they are free to practice without unnecessary supervisory requirements. Third, expand the pool of providers available to North Carolinians by knocking down artificial barriers to telehealth such as state licensure laws.
And that’s what we’re fighting for here at Locke: expanded access to care and downward pressure on costs. Medicaid expansion won’t deliver. Market reforms will.