This post appears here courtesy of the John Locke Foundation
. The author of this post is Brian Balfour
Axios is reporting
that North Carolina Senate Republicans are expected to file a bill that would expand Medicaid in North Carolina.
The bill would also reportedly include expanding scope of practice for registered nurses and loosen some Certificate of Need regulations.
Such a measure would be a reversal of the 2013 legislation
approved by the legislature and then-Gov. Pat McCrory promising that "the State will not expand the State's Medicaid eligibility"
as provided in Obamacare.
For the better part of a decade, the Locke Foundation has opposed Medicaid expansion for several reasons. While not an exhaustive list - a more comprehensive case against Medicaid expansion can be found here - below are 6 reasons North Carolina should not expand Medicaid.
1.) Medicaid expansion would significantly expand the number of North Carolinians dependent upon government for their healthcare coverage. Recent estimates place the number at 600,000, while some research suggests that more than half of those will already have private coverage.
Moreover, oftentimes estimates of increased enrollment underestimate actual enrollment figures under Medicaid expansion. For instance, after Louisiana expanded Medicaid, actual expansion enrollment was 65% higher than original estimates.
Increasing government dependency while expanding the size and scope of government programs is decidedly not a conservative value.
2) Coverage does not equal access to care. Well over 2 million North Carolinians are already enrolled in Medicaid, a number that has swelled by nearly a million people in twenty years - at a time when doctors are already increasingly overwhelmed, the question remains: who will Medicaid enrollees see when they get sick?
3) Healthier people crowding out care for more needy populations. The majority of those eligible under expansion would be able-bodied, childless working-age adults. Under expansion, these people would be competing for scarce medical care, and will often crowd out access to care for the traditional Medicaid population, which includes poor children, pregnant mothers, and those with certain disabilities
4) The federal government is broke and dysfunctional. Medicaid is considered a partnership between state and federal governments, but the federal government really runs the show. The feds fund the bulk of the expenses and dictate many of the rules. With the federal government running trillion-dollar deficits and weighed down by an unfathomable $30 trillion in debt, where will the billions in dollars come from to finance Medicaid expansion? Most likely, it will come from additional deficit spending financed by newly-created money, which will further exacerbate price inflation crippling so many households already. Why would North Carolina legislators want to make our state more dependent on the federal government?
5) Economic volatility. Many indicators are pointing to a coming economic slowdown, or even full-blown recession. When that happens, people will lose their jobs and Medicaid rolls will expand. Do legislators want to willingly expand Medicaid to 600,000 people through expansion at the same time tens, or hundreds, of thousands of more North Carolinians will be enrolling in Medicaid after suffering job losses?
6) Chasing short-term funding makes bad long-term policy. Thanks to the American Rescue Plan Act, states that expand Medicaid right now would be eligible for heightened levels of reimbursements from the feds. Some estimates project North Carolina could receive $1.2 billion in additional funds. The problem, however, is that these one-time funds would quickly run out, leaving North Carolina with a sizeable financial gap to fill. Using one-time money to fund recurring obligations never makes for good policy.
There's no question that rising health care costs, the uninsured, and lack of access are issues worthy of attention. But expanding Medicaid will only make those problems worse.
Instead, legislators should instead focus on market-based reforms, peeling back the many layers of government regulation that drive up costs and restrict supply. The two provisions reportedly included in the Medicaid expansion bill are among such reforms. And there are many others that should be considered.