Cooper administration keeps beating the Medicaid expansion horse

Published August 6, 2020

By Donald Bryson

On August 4, Missouri became the latest state where voters chose to expand Medicaid under Obamacare, approving the measure in a ballot referendum conducted concurrently with the statewide primary elections. 

On August 5, at Gov. Roy Cooper’s press conference to announce a five-week extension of Phase 2 coronavirus restrictions, Health and Human Services Secretary Mandy Cohen did not hesitate to get in front of news cameras and say North Carolina should follow Missouri’s ill-advised lead.

Medicaid expansion under Obamacare has been a top priority for the Cooper administration – dating back to his first week in office when he began a failed attempt to circumvent state law and expand Medicaid through executive action.

The fact remains that expanding Obamacare is a bad idea for North Carolina.

Every state that has implemented Medicaid expansion has seen costs shoot dramatically above projections. The expansion of Medicaid, again a policy relic of Obamacare, has hit some states harder than others. California saw its expansion-related costs balloon to 278 percent above what their lawmakers projected. Even the more conservative-leaning Kentucky experienced sticker shock as they discovered their projection missed the mark by 95 percent. 

I have previously written about Louisiana, where officials initially claimed that only 306,000 individuals would sign up for Medicaid expansion, the rolls soon swelled to over 505,000 —a 65% increase over the original projections.

When North Carolina state government is facing a $4 billion budget shortfall, primarily due to the coronavirus pandemic’s effects, it is silly to expand an entitlement program that is only now recovering from years of massive cost overruns.

Additionally, Medicaid expansion is antithetical to the “flatten the curve” mantra that we have all come to repeat since March. The curve of concern in that statement is the patient capacity for healthcare facilities in North Carolina. By proposing Medicaid expansion now, Secretary Cohen and Gov. Cooper are proposing to increase state Medicaid rolls by nearly half a million people (the majority of whom are on private insurance), while not increasing the number of healthcare providers or facilities in the state. In other words, they want to make sure we have more patients, but the same number of doctors, amid a global pandemic.

The irresponsibility of this idea is clear.

The experiences in other states should be massive red flags for North Carolina. The truth is Medicaid expansion is a budget buster that we cannot afford without robbing resources from other priorities and the truly needy – while trying to fill budget holes that already exist.

Medicaid expansion will not create jobs and prosperity. It is not a silver bullet to save rural hospitals. And North Carolina’s healthcare providers, particularly in the coronavirus context, cannot meet the new capacity from Medicaid expansion.

It is time for the Cooper administration to stop beating the Medicaid expansion horse, and find real solutions for North Carolina’s healthcare sector.

If you are interested in market-based healthcare reforms for North Carolina, you can read about them here, or visit