by Katherine Restrepo
Director of Health Care Policy, John Locke Foundation
This month, the Urban Institute and the Robert Wood Johnson Foundation released a report assessing the financial impacts of North Carolina’s decision to forgo the Affordable Care Act’s optional Medicaid expansion.
Extending eligibility rolls of our broken — yes, broken — medical assistance safety net would cost state taxpayers an additional $300 million per year, amounting to $3 billion to the General Fund books over the course of a decade. But because Medicaid is jointly funded by the state and federal governments, advocates brush that aside and are instead fixated on North Carolina losing out on $40 billion of federal funds over the next ten years.
The argument goes that our citizens’ federal taxes are now paying for other states’ Medicaid expansions, without any benefit coming to those citizens themselves. Is North Carolina really "losing out"? The influx of federal funds is borrowed money. What’s really happening here is that future generations are being taxed to broaden the safety net of our current generation, all the while adding to our national deficit.
Furthermore, the study projects an expansion would insure over 400,000 North Carolinians in 2016. However, a portion of this population would no longer qualify for subsidized private coverage under the federal health law. Essentially, these individuals would be pulled away from private coverage to a public assistance program where accessing care proves to be more difficult. In North Carolina, approximately one in every four physicians does not accept new Medicaid patients.
A central question to consider is this: Will consuming more money generate better patient health outcomes?
While Medicaid is a public health insurance program originally designed to help the most vulnerable populations, it generally fails to fulfill its good intentions. Thus, reforming the current system ranks as a higher priority. Avik Roy, editor and principal author of Forbes’ Apothecary blog, just released Transcending Obamacare, a lengthy proposal on how states can realistically pivot towards decentralized health care delivery initiatives that ultimately reduce the number of uninsured and increase access to care — including for those on Medicaid.
Within his report, Roy cites numerous landmark studies that raise eyebrows as to Medicaid’s effectiveness. See examples below, and click here to read more of the case studies.
Meanwhile, here are just a few of Transcending Obamacare’s proposed solutions for a more fiscally sound and efficiently administered Medicaid program:
Click here for the Health Care Update archive.
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