Human costs of Medicaid expansion

Published February 9, 2016

by Katherine Restrepo, John Locke Foundation, February 9, 2016.

North Carolina would face a substantial fiscal impact if the legislature agreed to opt for Obamacare’s Medicaid expansion. But expansion also would lead to human costs. I’ll touch on three:

1. Private coverage crowd-out 

If North Carolina were to expand Medicaid, approximately 180,000 North Carolinians who currently benefit from a heavily subsidized private coverage plan with incomes between 100 percent and 138 percent of the federal poverty level would be thrown into Medicaid — with its track record inferior to private health insurance. As a result, expansion of eligibility levels for government health insurance programs would crowd out access to private coverage.

Studies indicate that the crowd-out effect contributes to the fact that six out of 10 people on Medicaid once had private coverage. Expanding Medicaid would add an additional 500,000 enrollees to our state’s Medicaid program.

The heavier the Medicaid caseload, the more providers will have to make up for being paid below market levels by negotiating higher payment through private carriers — ultimately passing on these costs to consumers in the form of higher premiums. The Galen Institute explains:

In 2008, Milliman, the leading health insurance consulting firm, estimated that the average American family with private health insurance paid $1,800 more in premiums because of this cost-shifting phenomenon. By dramatically expanding Medicaid, states will impose a hidden tax on tens of millions of people with private insurance.

2. Deteriorating Access To Care 

People often interchange the terms “health coverage” and “health care,” but they are two very different concepts. At present, one in four physicians in North Carolina does not accept new Medicaid patients. Granted, Medicaid acceptance rates rank above average in this state compared to other states, yet access to care can deteriorate with more patients on the program.

Medicaid was originally designed for low-income mothers, children, pregnant women, plus the elderly, blind, and disabled — our nation’s most vulnerable citizens. Qualifying for Medicaid was originally based on the condition of either having a severe disability or dependents.

Expanding eligibility for Medicaid puts traditional program enrollees at greater risk. They will have to compete with a half-million more people for adequate access to health care — 82 percent of whom are able-bodied childless adults. The Foundation for Government Accountability cites this statistic from the Urban Institute in the chart below:

3. Health Outcomes 

Medicaid fails the poor. Avik Roy, senior fellow at the Manhattan Institute and Forbesopinion editor, even wrote a book about it. It is called How Medicaid Fails The Poor. Roy extrapolates on this by referencing the 2008 Oregon Health Insurance Experiment, the gold standard of studies in which a randomized control trial tested whether Medicaid is significantly effective when measuring blood pressure, high cholesterol, hemoglobin levels, and long-term cardiovascular risk between a cohort of patients on the program compared to a similar number of patients who remained uninsured.

Two years later, the authors detected that, overall, Medicaid had no significant effect on measured health outcomes between the patients randomly assigned to Medicaid compared to those not having insurance.

Just looking at the background story of how the OHIE came about points out Medicaid’s recurring health care cost and access problems. In 1993, Oregon expanded its Medicaid program to the working poor. It wasn’t too long until actual enrollment exceeded projected enrollment, causing a state budgetary crisis.

Oregon therefore froze its Medicaid enrollment and eventually reopened it to allow for an additional 30,000 newly eligible enrollees to apply for a Medicaid lottery out of a waiting list of 90,000 people.

Funding a problem doesn’t solve a problem. There are ways to make health care more affordable and accessible with less government intervention.

Katherine Restrepo is Health and Human Services Policy Analyst for the John Locke Foundation.

https://www.carolinajournal.com/opinion-article/human-costs-of-medicaid-expansion/

February 9, 2016 at 10:08 am
Norm Kelly says:

'make health care more affordable and accessible with less government intervention.' Should be nuff said. That actually says it all. Less government involvement automatically, by default, and naturally makes EVERYTHING more affordable. Beyond question. Unless you are a die-hard, lib, socialist who doesn't care about FACTS and only cares about feelings.

No lib can point to socialized medicine anywhere in the world that costs less, provides better coverage, and isn't a drag on their economy. Not even Mike Moore can provide facts showing any different.

The idea of socialized medicine has NOTHING to do with better care, better coverage, less cost. Socialized medicine has EVERYTHING to do with feeling good about GIVING more stuff to those who "can't afford" it by using OTHER PEOPLE'S MONEY! Like every good socialist scheme, it requires people who don't or won't use the scheme to pay for the scheme for those who actually use the scheme. Typical lib speak: tax the wealthy; they don't pay their fair share anyway; and besides, they can afford it.

But at some point even the wealthy become over-taxed. They only have so much money for libs/pols to steal before they stop being 'the wealthy'. And how many 'wealthy' does it take to pay for all the schemes loved/desired by libs/socialists? How much will Bernie's schemes cost 'the wealthy'? And what will be the hidden costs to the 'non-wealthy' among us? Cuz it's obvious, even to Bernie, Billary, and every other socialist out there, that there are hidden costs in every socialist scheme that negatively affects all of us. It's just that libs refuse to recognize these hidden costs. And more times than not, libs refuse to acknowledge that these hidden costs exist. And sometimes, they know the hidden costs aren't hidden, but push forward with their schemes anyway. Cuz it 'feels good'.