If North Carolina decided to opt for Medicaid expansion (thank goodness it has not), 500,000 additional citizens would receive Medicaid benefits. Currently, 1.8 million North Carolinians enroll on Medicaid. This is what is seen.
However, there are many unintended consequences that go unseen in the world of Medicaid expansion. Here are just a few:
- Although 76% of physicians in the state accept new Medicaid patients through the Community Care of North Carolina (CCNC) medical-home model, an increase in enrollment may cause more strain on accessible care, especially with the projected “doc shortage” by 2020. Keep in mind that coverage is not the same as care.
- Medicaid is funded by both the state and federal government. The poorer the state, the more federal funding the state receives. Expansion money will reduce North Carolina’s federal match rate (FMAP) of 65%, thus increasing state Medicaid spending.
- Medicaid patients have worse health outcomes than patients without insurance.
- Because Medicaid pays medical providers at much lower rates than private insurance, providers and hospitals increase rates to private payers to offset the low reimbursement. Therefore, expansion causes more patients to lose private coverage simply because they are unable to afford it. These patients who have lost private coverage are faced with enrolling in a public assistance program that does not provide as high quality care. This phenomena is known as private coverage “crowd out”.
