Duke University Health Policy Expert: The Case Against Medicaid Expansion in North Carolina
Article knocks down arguments about Medicaid expansion that Democrats continue to use today
Raleigh, N.C. – Earlier this week, Democrats continued their efforts to expand Medicaid in North Carolina, holding a hearing on the topic at the legislature. In light of that renewed push, it’s worth revisiting an article published in the North Carolina Medical Journal in 2017. Christopher Conover, a Research Scholar in the Center for Health Policy & Inequalities Research at Duke University, outlined a number of reasons why Medicaid Expansion is not a good idea for North Carolina that directly rebut some of the benefits being touted by Democrats. .
1) Medicaid Expansion Will Reduce Access for Existing Medicaid RecipientsConover explains that due to Medicaid’s low reimbursement rates, many Medicaid enrollees already have difficulty locating a provider, an issue that expanding Medicaid would only exacerbate:
” A model developed by the Cecil G. Sheps Center for Health Services Research at the University of North Carolina at Chapel Hill showed that, in the year 2020 alone, Medicaid expansion would increase the unmet demand for physician services by over 25%. In the context of this physician shortage, it makes little sense on ethical or clinical grounds to divert care away from existing Medicaid beneficiaries, who are among our most vulnerable populations—elderly individuals, persons with disabilities, pregnant women, infants, and children. “
2) Medicaid Expansion is Unlikely to Save LivesConover points out that there is no concrete evidence to back up the argument that expanding Medicaid will save lives:
“The best available evidence regarding Medicaid’s actual impact on health and mortality risk comes from the Oregon Health Study, which is as close to a randomized controlled trial as we might ever get on this question. In that study, Medicaid ‘generated no significant improvement in measured physical health outcomes,’ nor did it result in a statistically significant reduction in mortality risk.”
3) Medicaid Expansion is Unaffordable in the Long RunConover makes the point that it is extremely unlikely the federal government will continue to fund Medicaid expansion at the current levels, especially considering the fact that enrollment levels and the cost of expansion have been much higher than predicted:
The most recent annual report on Medicaid’s finances issued by the US Department of Health and Human Services (HHS) showed that the average cost of the ACA’s Medicaid expansion enrollees was nearly 50% higher in FY 2015 than HHS had projected just 1 year previously. Additionally, enrollment exceeded projections in states that elected to expand Medicaid by 110% nationally, and this problem has been much more severe in some states. Expansion enrollment exceeded projections by 322% in California, by 276% in New York, and by 134% in Kentucky. “
4) Medicaid Expansion will Eliminate More Jobs than it CreatesClaims that expanding Medicaid will bring thousands of new health care jobs to North Carolina is one of the benefits of expansion that supporters continue to mention, but Conover points out that these jobs come at a cost:
“The RAND Corporation has shown that every new job added to the health care sector results in 0.85 fewer jobs in the rest of the economy. Even worse is that every $1 raised in taxes shrinks the economy by 44 cents. This implies we would lose 144 jobs for every 100 health sector–related jobs that might be induced by expansion. In the end, then, Medicaid expansion is not merely a break-even proposition that shifts jobs from the general economy into the health sector: it actually reduces total employment in the economy overall.”

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