Proponents parade Medicaid expansion as a policy that will save lives at little to no cost to the taxpayer. But in the end, Medicaid expansion consistently shatters projections, eats up state budgets, burdens hospitals, and ultimately hurts the truly needy.
Medicaid was originally intended to provide health insurance for specific populations of low-income individuals: children, the elderly, and people with disabilities. It was then expanded to include pregnant women.
In 2010, ObamaCare allowed for expansion to include able-bodied adults who make an income that is less than 138 percent of the federal poverty level (FPL).
Since then, many states have caved and expanded Medicaid to able-bodied adults. Other states are holding out on expansion but face immense pressure from the Left to give in and join the party.
Medicaid expansion is painted, by the Left, in sunshine and rainbows, but the reality is much, much dimmer. The best way to counter the Left’s claims on Medicaid expansion is by simply looking at how it’s worked out for states who have implemented it.
The Left argues that Medicaid expansion will provide coverage for the uninsured.
In reality, Medicaid expansion moves thousands of people off of private insurance plans and onto Medicaid.
More than 54 percent of those who would qualify for Medicaid if their state expanded already have private health coverage. In some states, that’s as high as 71 percent. Currently, people who are between 100 and 150 percent of the FPL can get private, silver-level plans on the ObamaCare exchange at no cost to themselves.
However, when states choose to expand Medicaid, able-bodied adults with income between 100 and 138 percent of the FPL become eligible for Medicaid and automatically lose access to the free, private health insurance plans.
Expansion doesn’t make up for a coverage gap—rather, it would force able-bodied adults off of private insurance, which provides better coverage—and onto Medicaid.
The Left claims Medicaid expansion will come at low or even no cost to states and taxpayers.
To the contrary, the data doesn’t lie: Medicaid expansion always ends up costing more than states ever anticipate.
In states that expand Medicaid, enrollment numbers consistently shatter projections. Some states have enrolled twice as many—sometimes even four times as many—people as they ever said they would enroll.
The natural consequence of this is that Medicaid costs also shatter projections and crowd out other budget priorities. California, for example, enrolled 278 percent more people than planned. Because of this, they ran into a $54 billion deficit that forced them to cut money from education to foot the bill.
This is a common occurrence in expansion states: Massive budget shortfalls result in fewer resources available for priorities like education, transportation, law enforcement, and other programs that benefit the truly needy.
Medicaid expansion helps hospitals financially and it creates health care jobs.
In reality, Medicaid expansion often causes financial burdens for hospitals.
Proponents of expansion consistently argue that the policy would improve the financial health of hospitals, but this promise has yet to materialize in states that have expanded Medicaid to include able-bodied adults.
Studies show “no significant difference” in improved financial status of hospitals in expansion states compared to states that rejected ObamaCare expansion.
Specifically, Medicaid has a reimbursement rate of about 60 percent of private insurance. So when expansion shifts thousands of people from private insurance to Medicaid, the program is bringing hospitals more patients on which they lose money.
The Left claims that Medicaid expansion saves lives.
The realities of Medicaid expansion indicate that health outcomes are not better with expansion, and it may even increase risks for vulnerable populations.
Medicaid expansion forces more people onto health coverage that is objectively worse than private coverage. Fewer providers accept Medicaid because the reimbursement rate is so much lower than for patients on private insurance. This means it can be harder for enrollees to find providers—especially specialists and surgeons—who accept Medicaid. It goes without saying that difficulty finding a provider can result in delayed diagnosis or can result in serious illnesses going untreated.
Further, Medicaid isn’t a cure-all for increasing access to health care services. States can opt into the home and community-based (HCBS) waiver program which provides additional Medicaid services to those who would otherwise be placed in a nursing home or institution. However, space is limited and once it reaches its cap, individuals are placed on waiting lists.
The truly needy that qualify for HCBS waivers—people with severe intellectual or developmental disabilities, traumatic brain injuries, spinal cord injuries, debilitating mental illnesses, etc.—wait for the care they need while the able-bodied receive Medicaid services. Nearly 22,000 people have died waiting for care in states that have expanded Medicaid.
The Left’s Medicaid Arguments Don’t Stand Up to Scrutiny
Advocates for Medicaid expansion have lost sight of the program’s initial intent: to help the truly needy. Instead of helping vulnerable populations, Medicaid expansion has only served to force people off private health coverage, burden hospitals, and consume more of state budgets.
It’s not hard to counter the Left’s arguments for Medicaid expansion. The examples of the unfortunate effects of the policy on the people it portends to help in states where it has been implemented should be enough to deter any other state from making this same mistake to expand Medicaid.