A look at Medicaid expansion for NC

Governor Roy Cooper refuses to sign a budget without Medicaid expansion.

The Republican legislative leaders have opposed expanding the federal program since winning control of the General Assembly in 2010.

Cooper, a Democrat, touts expansion as the solution to virtually every problem facing the state.

Republicans are concerned that the program is broken - rife with fraud, poor outcomes, and a funding model that will leave the state facing multi-billion dollar shortfalls again.

The GOP rushed a bill through a House committee yesterday - in what appears to be cover for Democratic lawmakers to override the Governor's budget veto. It's not likely to clear the Senate.

It's been about a decade since the Affordable Care Act was passed, and so we now have some data to examine about what impacts Medicaid expansion can have.

In short: it's a mixed bag.

Primarily, it seems like a way to shift costs from private insurance customers to taxpayers (who are, generally, the same people). Except the money gets washed through the government bureaucracy first.

The Henry J. Kaiser Family Foundation summarized 202 studies of the impact of state Medicaid expansions under Obamacare. It found an increase in the number of people covered. This is unsurprising, as it's only logical that when you offer free coverage to people, more people will be covered.

It found mixed results on the financial impacts to state and federal governments. In the early days the feds were paying more of the costs. But as states had to pick up more of the costs in recent years, the overall effects are shifting. Still, federal taxpayers are paying more of the cost of the expansion patients than they were paying for the pre-expansion patients.

In other words, a doctor receives less reimbursement for seeing a patient who enrolled in Medicaid pre-ACA than a patient who enrolled under the expansion. (These new patients also have fewer restrictions to get enrolled.)

The Kaiser study also looked at outcomes:

Access to care, utilization, affordability, and health outcomes: Most research demonstrates that Medicaid expansion has positively affected access to care, utilization of services, the affordability of care, and financial security among the low-income population. However, findings on provider capacity were mixed, with some studies suggesting that provider shortages are a challenge in certain contexts. Studies show improved self-reported health following expansion, and multiple new studies demonstrate a positive association between expansion and health outcomes. Further research is needed to more fully determine effects on outcomes given that it may take additional time for measureable changes in health outcomes to occur.

People FEEL like they're getting better care - which drove assessments in the early days of Medicaid expansion. "Multiple new studies indicate a positive association" - which isn't really definitive. So, more research in the coming years is needed to find out if it's really leading to better health care and outcomes.

Meanwhile, some studies suggest "provider shortages are a challenge in certain contexts." Which is precisely what critics have been saying.

When more people show up at a doctor's office with Medicaid "coverage" - it means the doctors will need to charge more money to other patients. Or they'll just stop seeing new Medicaid patients.

Which is what many are doing.

Because coverage doesn't equal care.

And then there's the costs.

From the liberal think tank Brookings Institution:

Although it is unlikely that Medicaid expansion will turn out to be entirely free to states, based on the considerable experience to date, the probable costs appear to be quite low in comparison with the economic and public health benefits of expansion.

Of course it's not free. Someone is paying the costs. Or will be.

As Dr. Merrill Matthews noted in 2012:

Expansion advocates claim that the federal government will absorb most of the cost of the newly eligible Medicaid enrollees—100 percent for a few years, dropping to 90 percent by 2020. That’s much larger than the average 57 percent share the federal government now pays.  What a deal!
But those advocates sound like the spendthrift spouse after a shopping spree who boasts about all the money that was saved; what the fiscally responsible spouse wants to know is how much money was spent. Expanding Medicaid will still cost states billions of dollars, even at the reduced state share. And taxpayers are still paying for the coverage; the taxes—actually, borrowed money—are just coming from the feds rather than the state.

Also, there is no guarantee that the federal government will continue funding the half-a-trillion dollar program at the promised level.

If the goal is to provide health care to the poor, there are other ways to do so.

However, if the goal is expand government control over the health care system in order to advance the American society towards a single-payer or government-run system, this is a good way to do it.

Pete's Prep: Wednesday, July 10, 2019

  • Joseph Colletti at the Carolina Journal highlights how Gov. Roy Cooper's "compromise" budget plan is really not much of a compromise at all.
  • The fight between NC State Treasurer Dale Folwell and hospitals over ambiguous and inflated costs charged to the State Health Plan is getting hotter.
  • Greg Murphy won the Republican runoff for US House in NC District 3 yesterday.
  • Jimmy Johns in downtown Asheville closes, and locals take to Facebook to rejoice because it's a chain restaurant and the corporate owner is a big game hunter.
  • America's largest teacher union - the NEA - formally endorsed abortion. For the children, I'm sure.

Pete Kaliner

Pete Kaliner

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