Medicaid Expansion Blues: The shape of things to come?

Published May 23, 2024

By Brant Clifton

Medicaid expansion got sold to us in 2023 as the greatest thing since sliced bread.  Tons of legislators who had mouthed a lot of sincere-sounding objections to growing the government to this extent performed a smoother 180 than you’ll ever see at your local skateboard park.  They followed their imperious leaders Phil Berger and Tim Moore into the big government abyss.

The federal government is paying for most of this, we were told.  It’s not going to bust our budget, we were told.  (I’m already hearing from some Jones Street moles that they’re hearing the feds are planning to pay a whole lot less than what was promised prior to the expansion vote in Raleigh.)

Check out what’s happening right now in Mecklenburg County. They’re apparently mulling over a FY2025 budget:

Okay.  They’ve got a loss of revenue thanks to $2.3 million in “lost Medicaid reimbursements.”  *Gosh. That sounds a lot like what expansion opponents told us during what little debate there was in Raleigh.*

New resources,” eh?  In other words, “things that were not funded last year.”  Take a guess where the money for this “new” stuff comes from.

Notice the $450,000 line item in the middle of that list?  Much of the rest of this list looks like Medicaid as well.

This is just ONE out of 100 counties.  You have to wonder about the hit those other 99 counties will be taking and how it affects our future tax bills and the services we receive. 

States got some extra help on Medicaid during the pandemic years.  That $$$ / “help” is going away and look what appears to be happening:

[…] State Medicaid costs are expected to rise dramatically by the end of the current budget year. Survey data from the Kaiser Family Foundation shows that state costs rose by 13% in fiscal 2023 and are expected to increase by an additional 17.2% in fiscal 2024. In their survey responses, states identified the phaseout of enhanced federal Medicaid aid, provider rate increases, and slowing but still elevated enrollment levels as key drivers of these increased annual costs, which, coupled with weakening tax revenue collections, are likely to push up the share of state funds spent on Medicaid going forward. […]

SO, it is anticipated that the state share of costs on Medicaid will keep rising into the future.  And we ALL know where the state gets its money from.

Roy Cooper got a big political victory out of Medicaid expansion, despite being saddled with a legislature controlled by the OTHER party. The always-hungry hospital lobby got what it paid for.

It appears we’re about to get saddled with a bunch of new costs we weren’t told about during the sales pitch on expansion.  And the alleged defenders of our wallets, the so-called conservative party, are quietly whispering among themselves — trying to figure out how to avoid being ridden out of town on a rail.

I’ll say it again, folks. WE are soooooooo screwed.