BRYSON: Facts support rejecting Medicaid expansion in N.C.

Forms for North Carolina's Medicaid program

North Carolina lawmakers were right to repeatedly reject the idea of expanding Medicaid in the Tarheel state. They know that an expansion of Medicaid under Obamacare would endanger a healthcare program aimed at protecting North Carolina’s most vulnerable residents, in exchange for unsustainable costs and no guarantees of adequate access to quality healthcare for new enrollees.Advocates in favor of Medicaid expansion have repeatedly asserted fiscal myths to support their position, much like advocates for the original passage of Obamacare. The first is that North Carolina pays for other states’ Medicaid expansions.This claim has already been thoroughly debunked by the Congressional Research Service. There is no magic pot of money being paid for by states and doled out to those who expand Medicaid. All Medicaid expansions are paid for with new federal spending, and add to the already staggering $19 trillion national debt. In 2014 the refusal to expand Medicaid in dozens of states saved at least $26 billion — this according to the Obama administration.Another common claim is that the expansion will cover 500,000 uninsured North Carolina residents. The truth is, hundreds of thousands of North Carolinians would be handed a government-issued insurance card as a result of a Medicaid expansion under Obamacare — not guaranteed actual care. What these new Medicaid enrollees may not know is that their new insurance coverage only pays doctors a fraction of what private insurance plans pay for the same medical care. As a result, many doctors do not accept Medicaid.In 2015, only 50 percent of physicians were currently accepting new Medicaid patients, down from 70 percent in 2011, suggesting that doctors are becoming increasingly less likely to accept new Medicaid patients. If North Carolina floods its Medicaid program with hundreds of thousands of new able-bodied, childless, working-age adults, not only will they struggle to find a physician, the strain may jeopardize the care of the vulnerable populations currently in the program.Finally, we’re told expansion will be fully funded by the federal government for three years and then funded at 90 percent thereafter — those who claim this should be aware that the three-year “grace period” is a set time period from 2014 to 2016. If North Carolina expands Medicaid next year, it will be responsible for paying for a portion of the program in 2017, just like every other Medicaid expansion state. And while it is true that the president’s healthcare law does promise to pay for 90 percent of each state’s program in perpetuity, Congress could change this match rate through legislation at any time. Given that Medicaid is the fastest-growing entitlement in the federal budget, it is a prime target for reform as federal lawmakers try to rein in spending.Medicaid expansion advocates often point out other states that have chosen the “good health of their citizens” by expanding Medicaid. Examples often include New Mexico, Nevada and Ohio. Questionable examples, considering that New Mexico physicians and nurse practitioners have been struggling to provide care to the onslaught of lower-paying Medicaid patients that have entered the system — over 56,000 more people than the state expected in the first year of enrollment alone.Even worse, Nevada projected only 78,000 would ever enroll in that state’s Medicaid, yet, by early 2015 the program was serving more than twice that amount of people (over 166,000). Ohio, too, has experienced much larger-than-anticipated enrollment, which has created a $2.7 billion hole in the state’s budget in just the first two years of the program.The overruns in each of these states will jeopardize other critical budget needs, many of which are also extremely important to serving low-income residents — things like schools, roads, and emergency responder services. Several Medicaid expansion states have had to raise taxes or are considering doing so since they accepted the new entitlement.North Carolina has rejected Medicaid expansion precisely because it was the right thing to do.Donald Bryson is the state director of Americans for Prosperity North Carolina.