Democrats have always believed in Medicaid. They pushed the expansion of Medicaid through the Affordable Care Act (ObamaCare) and even tried to force every state to comply. The Supreme Court struck down that part of the ACA, but they still managed to convince a majority of states to expand their Medicaid rolls by promising them 100% federal support for three years.
Still not content with that achievement, now they’re at it again, this time trying to expand Medicaid eligibility to those who make too much money. Remembering the liberal mantra, “Never let a crisis go to waste,” they are using the Covid pandemic to accomplish their goal.
Chris Jacobs, writing in The Wall Street Journal, tells us a coronavirus relief bill signed by President Trump on March 18 included a 6.2% increase in states’ Medicaid matching rates for the duration of the pandemic. But the additional dollars came with a big catch: States can terminate Medicaid enrollment during the public health emergency only if “the individual requests a voluntary termination of eligibility” or moves out of state. No increase in income or assets, no matter how great, permits a state to disenroll someone from Medicaid.
The Congressional Budget Office (CBO) believes the pandemic will increase Medicaid enrollment by about nine million in 2021, and spending by $86 billion, next year compared to its March pre-Covid projections. The CBO estimates that “about half of the projected increase in enrollment . . . results from the new requirement that states allow people to remain enrolled in Medicaid longer,” meaning approximately 4.5 million otherwise ineligible people will remain on the rolls.
Jacobs tells us how this can impact a state by relating the Louisiana experience. Early last year, following an audit that showed people earning over $145,000 a year remained on Medicaid, the state began checking income eligibility on a quarterly basis. The audits led to the removal of 30,000 from Medicaid – including at least 1,672 with income of over $100,000 – saving taxpayers some $400 million.
But now with the Congress imposing the maintenance-of-effort provisions this spring, enrollment in Louisiana’s Medicaid expansion has exploded. From March through September, enrollment surged 16.5%, or more than 78,000, to reach all-time highs. The CBO’s assumption that the maintenance-of-effort requirements explain half of the enrollment increase suggests approximately 40,000 Louisianans have remained on expanded Medicaid after becoming ineligible – more than the state removed from the rolls last year.
To be sure, some would argue this is reasonable on a temporary basis to cope with the Covid pandemic. But that wouldn’t be enough for House Speaker Pelosi. She pushed through an ObamaCare “enhancement” bill that would require states to keep individuals continuously enrolled in Medicaid for 12 months before checking eligibility, at a cost to taxpayers of nearly $205 billion over 10 years.
If this were only about providing healthcare for people in need, I might support it. But Medicaid is the worst form of healthcare in this country, even worse than having no insurance at all, because it reduces access to healthcare. I have written extensively on this subject all the reasons this is true in this blog and in my book, The ObamaCare Reality.
Furthermore, the expansion of Medicaid not only increases our federal deficit, it saddles states with difficult budgetary choices between providing Medicaid versus education, law enforcement, and infrastructure. Jacobs summarizes, “With federal debt soaring, neither states nor Washington can afford to keep ineligible individuals on the Medicaid rolls. Democrats are showing the fiscally irresponsible nature of their drive to expand the welfare state.”