Today state legislative leaders announced what had been rumored to be coming for the past year: an agreement to expand Medicaid as provided for by Obamacare.
Reportedly included in the plan are work requirements, some Certificate of Need (CON) reform, and the SAVE Act. CON reform is certainly welcome, but if it comes as a package deal with Medicaid expansion, full CON repeal should have been on the table. SAVE Act reforms, which involve expanding the scope of practice for nurse practitioners and other licensed healthcare professionals, will also help increase access to care, especially in rural areas.
Unfortunately, however, the “largest expansion of entitlements in state history” – as Locke President Donald Bryson called Medicaid expansion – will overwhelm the already stretched-thin Medicaid program even with the modestly positive reforms included.
Legislators are justifying their decision in large part based on a sweetener offered by the federal government that would increase Uncle Sam’s share of covering the newly eligible, reported to bring an extra $1.5 billion.
Moreover, the legality of work requirements in Medicaid has been questioned by the Biden administration, with a dozen states having been stymied over the past couple of years.
The Locke Foundation has for many years opposed Medicaid expansion in North Carolina, for several reasons. The financial sweetener from the $31 trillion-in-debt federal government doesn’t change things. Here are three main reasons Medicaid expansion remains a bad deal for North Carolina:
- Coverage does not equal access to care. There are now 2.9 million North Carolinians enrolled in Medicaid. Fifteen years ago, enrollment was 1.8 million, which marks a 61% increase. Adding 600,000 would bring that to 3.5 million, nearly doubling the number of enrollees since 2008. The result would be roughly 1 in 3 North Carolinians enrolled in the government program. And during this time of massive swelling of the Medicaid rolls, the number of hospitals accepting Medicaid patients has fallen by 15%, and the number of physicians enrolled as Medicaid providers has risen by only 11%. Dentists accepting Medicaid has fallen by 35%. Expansion may provide people with a Medicaid card, but that card does not guarantee timely access to care.
Expansion may provide people with a Medicaid card, but that card does not guarantee timely access to care.
- Healthier enrollees will crowd out the more needy traditional Medicaid population. The expansion population will be mostly childless, working-age, healthy adults. But with the federal government’s more generous coverage of the expansion population, the incentives exist to favor the expansion population over the traditional Medicaid population that is mostly low-income parents, children, pregnant women, the elderly, the blind, and the disabled.
- NC is NOT subsidizing expansion in other states, there is no Medicaid pot o’ gold. There is a myth perpetuated by supporters of expansion that NC and other states are all paying into some pot of funds designated specifically for Medicaid expansion. If NC doesn’t snatch up its share of this pot of gold it’s already paying into, other states will. So NC might as well claim its share, goes the claim. This claim, however, is false. There is no designated Medicaid fund, and never was. Instead, every increase in federal spending that arises from states expanding Medicaid is new spending that increases the national debt. By refusing Medicaid expansion, North Carolina is reducing federal spending and the national debt.