When Medicaid expansion comes knocking, NC shouldn’t answer
It’s an election year, which means that while other states are close to ending their legislative sessions, North Carolina is still waiting on its legislative “short session” to begin.
It is common for oversight and study committees to meet between legislative sessions, and this year is no different. However, one such committee – the Joint Legislative Oversight Committee on Access to Healthcare and Medicaid Expansion – is poised to take North Carolinians down an entirely different, and worrisome, path.
Special interest groups continue to pressure the Republican leadership at the General Assembly to expand Medicaid under Obamacare, despite the financial burdens it will level on taxpayers.
The Obama administration promised states that Washington would pick up 100% of the expansion costs for the first three years and then 90% after that — but how reliable is this guarantee from a federal government that is $27 trillion in debt, much of which is due to Medicaid?
Moreover, unforeseen costs have been a constant problem for Medicaid. For example, Medicaid expansion in Louisiana was expected to cost about $1.4 billion per year. Instead, it has cost taxpayers an estimated $3.1 billion per year — more than twice the Legislative Fiscal Office’s original estimates, according to the Pelican Institute for Public Policy.
A 2020 study from the John Locke Foundation found that Medicaid expansion in North Carolina would create a significant gap in the state budget. This funding gap of $119.3 million to $171.3 million in the first year alone would have to be made up through new state appropriations, increased taxes on managed care plans, or higher taxes on providers.
Additionally, renewed calls for Medicaid expansion also come when the state’s Medicaid program continues to transform into a new managed care model, which expansion would confuse and disrupt.
North Carolina has been a leader in enacting free-market reforms at the state level to improve people’s lives. The past decade’s tax reforms have reduced the burden of government and simplified the filing process for millions of Tar Heel families. The expansion of school choice has created opportunities in our state, and the rejection of Obamacare’s Medicaid expansion has helped protect North Carolina from a critical aspect of the federal government’s health care takeover.
Fortunately, the United States Supreme Court ruled the Biden-Pelosi-Schumer government in Washington cannot force states to expand Medicaid. The General Assembly has already exercised our state’s rights, rejecting Medicaid expansion and the additional Obamacare empty promises that would come with it by passing Senate Bill 4 — No NC. Exchange/No Medicaid Expansion — in early 2013. This bill prevented Gov. Roy Cooper from unilaterally expanding Medicaid in his first week in 2017.
The General Assembly should continue to hold the line and ignore calls for Medicaid expansion.
Medicaid expansion would inexplicably hurt the most vulnerable North Carolinians. Medicaid is a program meant for the most disadvantaged residents. However, because of Medicaid’s low doctor reimbursement rates, patients already have a tough time getting a doctor’s appointment, contributing to the program’s shockingly poor health outcomes. The expansion would add thousands and thousands of able-bodied, childless, working-age adults to Medicaid, further exacerbating the problem of access to quality care for the neediest North Carolinians.
As former Wisconsin Gov. Scott Walker — who rejected Medicaid eligibility expansion — told the Wall Street Journal, “Caring for the poor isn’t the same thing as taking money from the federal government to lock more people into Medicaid.”
Obamacare expansion via Medicaid is a shell game that’s bad for taxpayers and a bad deal for North Carolina’s economically disadvantaged families. When special interest groups come knocking after the legislative session starts, the General Assembly should keep the door shut.
Donald Bryson is president and chief strategy officer of the John Locke Foundation, a think tank in Raleigh.
