Expanding Medicaid – Again!


By now most people know the Democrats are pushing a massive spending bill through the Congress euphemistically designed for “human infrastructure.” It has been labeled a $3.5 Trillion bill by the White House but others, including The Wall Street Journal, have estimated it will actually cost about $5.5 Trillion or more.

However, few people realize part of this bill is intended to expand Medicaid, again. If you’ve followed my blog for years, you know that Medicaid was first expanded by the Affordable Care Act, passed without a single Republican vote, in 2010. We know this bill today as ObamaCare. ObamaCare originally mandated all states to accept the provisions of expanding Medicaid, which called for increased eligibility to 138% of the Federal Poverty Limit (FPL) in exchange for the feds picking up 100% of the tab for three years. After that the feds would decrease their subsidies to 90% and lower in subsequent years.

About half of the states, mostly blue, accepted this original expansion, but the other half, mostly red, pushed back. The issue was taken up by the U.S. Supreme Court in 2012 and they sided with Republicans. States could not be forced to accept the new Medicaid expansion formula. Many of the states that accepted the expansion have since regretted it as state budgets have been rocked by greatly expanded Medicaid rolls.  But some of the states that rejected Medicaid expansion have since accepted it. Currently there are twelve states that remain opposed to Medicaid expansion.

Those twelve states are a thorn in the eye of progressives who insist everyone must accept Medicaid. To solve this problem, they have devised a plan for expansion of Medicaid to all states by giving the Health and Human Services Secretary the ability to run a federal Medicaid expansion over state objections, starting in 2025.

Brain Blasé, writing in The Wall Street Journal, says before then the feds would send subsidies directly to health insurers to cover this population in Affordable Care Act exchange plans. The new federal Medicaid program would require the secretary to contract with at least two insurers to administer the program.

What’s wrong with this plan?

To the uninformed, this may seem like a good idea. You may think that expanding Medicaid provides healthcare to those who cannot afford it. Would that this were true! Everyone favors expanding healthcare, but does this really accomplish that noble purpose?

Medicaid is the worst form of healthcare insurance available in the U.S. First of all, many doctors will not accept Medicaid patients because the reimbursements are less than the cost of providing care. Blasé says a 2019 government report found that only 70% of providers accept new Medicaid patients, versus 90% for private coverage. Actually, this statistic is misleading. Many of those who say they accept Medicaid will severely restrict the number of appointments for these patients in their calendar. The result is Medicaid patients have great difficulty getting to see a doctor.  They lack access to healthcare. This leads to Medicaid patients flooding the emergency rooms for primary care.

An Oregon study in 2007 defined the ineffectiveness of Medicaid in providing healthcare. When Oregon residents had to sign up for Medicaid by a lottery system, two groups were established – those on Medicaid and those without healthcare insurance. But the results of the study showed the winners, those on Medicaid, fared no better than those without insurance in measures of blood sugar control of diabetes, blood pressure control, and other statistical measures. And the Medicaid patients were 40% more likely to be found in emergency rooms.

Medicaid expansion increases demand for healthcare but does nothing to increase the number of doctors or nurses who treat patients. In California, emergency room visits by Medicaid enrollees surged 75% from 2012 to 2016, according to a study from a state government health-planning office. States that expanded Medicaid also suffered larger increases in opioid deaths from 2013 to 2015, according to data compiled by HHS.

Blasé says the per enrollee Medicaid expansion cost is about $7000. He says surveys have shown at least half of enrollees would prefer $2,800 in cash to the $7000 of government spending through Medicaid on their behalf. While some might waste this money, those who use it for healthcare will find most doctors’ offices willing to greatly reduce their charges for cash patients, a practice unlawful for Medicaid enrollees.

Medicaid was originally designed for low-income pregnant women, children and those with disabilities. Expanding it to childless adults and able-bodied men will only look good on paper when counting the numbers of insured, but will not make a positive impact on the healthcare of these Americans.

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