Article: Principles and Medicaid Expansion

Author: R. Alan Harrop, Ph.D

Expanding Medicaid, which I believe will be a disaster for North Carolina (see prior article on this topic in a recent issue of County Compass and here) is on the agenda of the new General Assembly scheduled to begin their session later this month. Our elected representatives should be expected to reflect our values and principles when deciding how to vote on various issues addressed by the General Assembly. If they do not do so, they should be voted out of office. Seems pretty clear to me.

However, sometimes issues arise on which we as constituents have not expressed our views and therefore our position on those issues might not be known to our elected representatives. What should our elected representatives do under those circumstances? The ideal thing would be for us to be apprised of the nature of the issue and our opinion solicited by our representatives. Some of our representatives are very effective in communicating with their constituents through social media, emails, or town hall meetings. Congressman Greg Murphy for example, does a great job with his email based newsletters. Use of issue surveys conducted by party officials can also be of great assistance in determining constituent opinions.

There are some issues before the General Assembly that are seemingly complex and have various interested persons arguing for or against. Take expanding the number of people eligible for Medicaid (estimated to add 600,000 or more) in North Carolina for example. Advocates for expansion point to several economic reasons essentially about hospitals/ medical providers’ financial difficulties with the current system and available access to federal tax money. Those opposing Medicaid expansion frequently cite more dependence on the government, disincentive to work, Medicaid is already a failed program, problems in other states, and burdening taxpayers to pay for other healthy, working age individuals, etc. How is an elected representative to sort through all this and make the right decision?

The answer is actually very easy: Go back to conservative principles and what is best for the country! The biggest threat to our country at this time in its history is the Democrats push towards socialism. A person would have to be blind not to recognize that fact. The question then becomes does adding close to one million people in North Carolina to a government program move this country more towards destructive socialism? The leftist Democrat party and Governor Cooper have been advocating the expansion of Medicaid for years. Until recently, the Republican party has fought against it. Now, all of a sudden many Republicans are supporting Medicaid expansion or are considering doing so. Where are their conservative principles? Do they actually have any? Destroying this country for some economic reason is not acceptable. Fortunately, we do have at least a couple or reliable conservatives such as Representative Keith Kidwell and Senator Norm Sanderson who have stated their opposition to the expansion of Medicaid. Other representatives would do well to follow their example.

The Case Against Medicaid Expansion

Author: R. Alan Harrop, Ph.D

Just a reminder, Medicaid is a program that was started in 1965 to provide healthcare to the very poorest of Americans. In the last session of the General Assembly, the Republican controlled N. C. Senate voted to expand Medicaid, which has been advocated by leftist Democrats as part of Obamacare, in spite of their being opposed to expansion for several years. Why the dramatic shift in position? We have not been
told. Let’s take a look at why expanding Medicaid is a very bad idea and needs to be stopped.

First, expansion will greatly increase the number of people on this socialist program by an estimated 600,000 and possibly one million people in North Carolina.. The program is already failing with high costs, poor access to care and adding more people will make the situation worse.

Second, several states have tried this with dismal results. Louisiana, for example, expanded their Medicaid program in 2015. The number of people accessing the program is 65% higher than the original estimate and costs have ballooned from $1.4
billion to $3.1 billion. If all the states expand Medicaid, The Federalist estimates it will require a $1 trillion tax hike and a $700 billion in cuts to Medicare.

Third, a recent Civitas poll showed that 65% of respondents opposed Medicaid expansion when they learned that the “…expanded population was primarily healthy, working age adults with no children”. It is estimated that 60% will drop private healthcare coverage they already have. The working poor can already find inexpensive private healthcare coverage on the federal exchange.

Fourth, even though federal tax money will pay for about 90% of the initial cost, the state is liable for future costs and do not forget that it is still more money taken from the average tax payer. The existing Medicaid program already takes about 25% of most state budgets.

Fifth, expanding Medicaid (up to 138% of federal poverty level) is a giant step towards socialized, government controlled medicine which has already proven to be a problem in other countries. Remember Obama’s lie “ if you like your doctor, you can keep your doctor”. The more people on welfare, which is what this is, the less freedom of choice.

Sixth, All welfare programs encourage dependence on the government and reduce the incentive to work. We need fewer welfare programs not more.

Seventh, medical facilities, unable to survive on Medicaid reimbursement rates,
increase the cost of services to the owners of private insurance. Expect your premiums to go up as well as your taxes.

Eighth, the majority of individuals receiving Medicaid vote for Democrats in order to ensure continuation of the program. Expanding Medicaid will most likely turn North Carolina from a red to a blue state which is exactly what the Democrats are expecting.

There are other excellent reasons to oppose Medicaid expansion. Bottom line, this is an expansion of the Welfare State that no true conservative Republican should support. If you agree, contact your state legislators before it is too late. The slide to socialism must be stopped if we are to save America!


Benign-Sounding Policies Often Have Negative Consequences

North Carolina is a battleground state in this election. After a responsible State Treasurer and a responsible State Legislature brought us into fiscal solvency, we are in danger of forgetting where we have been and what it took to get where we are. Because of an influx of people fleeing high tax states with bad weather (guilty as charged), it is possible that North Carolina will become a purple state instead of a red state. Many of those people coming into the state are attempting to implement the very expensive state policies that they fled. That would mean that the hard-fought income tax decreases passed by the legislators would be undone and spending would increase drastically as it had under previous Democrat legislatures. One of these items currently being mentioned in the gubernatorial campaign is Medicaid Expansion. Governor Cooper supports it and Dan Forest does not.

On September 22, 2020, The John Locke Foundation posted an article explaining what Medicaid Expansion would mean to North Carolina.

The article reports:

Expanding Medicaid in North Carolina is a misguided and costly plan for our state, and would not be free to state taxpayers, as Gov. Roy Cooper claims. New economic analysis released by the John Locke Foundation reveals that expansion would leave the state with a funding gap estimated between $119.3 million and $171.3 million in the first year alone.

The expansion funding gap would continue every year and could increase based on enrollment in the program and cost of the enrollees in the future. Multiple North Carolina expansion scenarios are detailed by JLF Health Care Policy Analyst Jordan Roberts in the report, Big Government, Big Price Tag: Medicaid Expansion = Funding Gap For State Government.

…Nearly 2.4 million people are currently enrolled in North Carolina’s program. Gov. Cooper and state Democrats have fiercely advocated for overloading Medicaid with 500,000 to 600,000 additional people. Nearly eight of 10 of the proposed expansion population are able-bodied, working-age adults with no children, according to the Kaiser Family Foundation.

Gov. Cooper claims that adding this massive new group would not require any state money and that the state’s portion of costs would be paid for via taxes on hospitals and providers.

“The governor’s statement is wrong,” said Roberts. “Our modeling is rigorous and uses varying enrollment numbers and expenditure data from respected sources. The most likely modeled scenarios result in the need for state appropriations. That means taxpayers.”

Beyond the fiscal implications for the state, Roberts worries about the fate of those currently enrolled. “If massive numbers of new people are added, it will be harder to access care. Many current Medicaid patients have multiple health issues; they’re our most vulnerable. The worst thing we could do is to push their needs aside.”

We need to provide a way for all Americans to get the healthcare they need. However, we need to do it carefully–providing what is needed to the people who need it. The welfare state has grown so large that there is no concept of individual responsibility included in allocating resources. There is also no incentive for the overgrown bureaucracy to decrease the number of people getting assistance. It is time to encourage all Americans to take responsibility for their own economic welfare. That may mean providing a path out of government dependence rather than bringing them deeper into it.

The Cost Of Immigration

America is a country that was built by immigrants. People came here from Europe and other places to celebrate freedom, escape religious persecution, or simply to begin again. The Catholics fled the potato famine, the Jews fled the pogroms, and others came to buy land to farm and support a family.

Well, not all of today’s immigrants have the same sort of ambition. National Review reported today that 42 percent of new Medicaid recipients are immigrants.

The article reports:

Federal law bans the admission of immigrants who are likely to be significant beneficiaries of welfare, technically a “public charge,” but that definition doesn’t consider in-kind welfare programs like Medicaid: U.S. Citizenship and Immigration Services defines being a public charge as “the receipt of public cash assistance for income maintenance or institutionalization for long-term care at government expense.” The USCIS union president has recently complained that President Obama is not enforcing public-charge laws.

Illegal immigrants are ineligible for Medicaid currently and are technically ineligible for the Medicaid expansion or any other direct Obamacare benefits, but fraud in the program is rarely investigated and recipient-level eligiblity is rarely investigated.

The article also reminds us that Medicaid has been expanded so that people with incomes up to 138 percent of the federal poverty line are eligible. This greatly increased the cost of the program.

I am not opposed to immigration, but I question the wisdom of an immigration policy that allows people to come here and be a burden on the federal government. Our federal deficit is out of control, why are we passing laws that make it worse?