On Friday, the Wilmington Star published an editorial listing the “Top 12 Reasons Why N.C. Should Expand Medicaid,” from their perspective.
All twelve miss the mark, and per usual, none of them address the question of how these additional 500,000 people will access actual care in the already overcrowded Medicaid system.
Let’s have a quick review an commentary of their 12 reasons (quotes are paraphrases from the article):
- 1. “Too many fall in the coverage gap of uninsured” – There are indeed still hundreds of thousands without health insurance in NC. But this fact alone does not mean we should expand Medicaid. There are far better alternatives available to make insurance more affordable for more people. Just because a problem exists doesn’t mean the reflexive ‘solution’ is a new or expanded government program.
- 2. “expansion would give coverage to 500,000 people.” Perhaps. But research shows that roughly 63% of them already have private insurance, and another 11% are eligible for free or heavily subsidized insurance on the Obamacare exchange. In short, 3 out of 4 potential expansion enrollees already have insurance or access to insurance.
- 3. “30k of the uncovered are ex-military, our veterans deserve better” Agreed, they do deserve better. But see above statement to question how many already have access to insurance. Moreover, jamming them into the already overcrowded Medicaid system would not guarantee access to actual care.
- 4 – 7 : “In expansion states, more babies lived to their first birthday, fewer women died in pregnancy, people with uncontrolled diabetes and hypertension dropped and fewer deaths from cardiovascular disease.” Most of these are merely correlation, not causation. Different demographics and lifestyle choices among populations of different states can better explain different health outcomes.
- 8. “we all pay for the uninsured when they use highly expensive emergency room services.” Not true. Academic research found that the uninsured don’t use the ED more than the insured, and in fact “the uninsured use the ED substantially less than the Medicaid population.” If there is concern over emergency room usage, Medicaid expansion would make that worse.
- 9. “On average, Medicaid expansion states see private health insurance premiums 7-11 percent lower than in non-expansion states.” This data draws on research done in 2015, a time when still relatively few states had even expanded Medicaid, and of those, many were still in their first full year of expansion, which is clearly not enough time to measure impact. More importantly, the research was done before many states saw insurers withdraw from the marketplace and the substantial insurance premium spikes in the last few years. This claim provides no indication of the current situation and cannot serve as an indicator for what would happen in N.C.
- 10. “Expansion states didn’t see any significant changes in employer offering of health insurance” – I don’t know why they even included this. Opponents of expansion rarely, if ever, make this claim.
- 11. “Expansion would require $0 in new state taxes” – But in the next sentence they admit the state share of the expense would be funded by “hospitals and health plans.” How would they be funding it? By paying a new tax. This rhetorical trick is what many call a “lie of omission.”
- 12. “There is energy on both sides for expansion.” So what? It doesn’t make it the right thing to do. Also, both sides differ on important aspects of expansion plans – namely work requirements and enrollees sharing in premium and co-pay costs.
