Friday, 19 February 2021 10:52

OPINION: N.C. lawmakers should continue to reject Medicaid expansion

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The two U.S. Senate elections in Georgia are over, and now the overall national election results are known. Democrats have declared their newfound control of both chambers of Congress. But equally significant events took place at the state level, where bold, free-market-friendly leadership was vindicated and advanced once again in North Carolina. 


North Carolina has been a leader in enacting free-market reforms at the state level that are improving people’s lives. The past decade’s tax reforms have reduced the burden of government and simplified the filing process for millions of Tar Heel families. The expansion of school choice has created opportunities for thousands of students in our state, which has become particularly important in the wake of COVID-19. And the rejection of Obamacare’s Medicaid expansion has helped protect North Carolina from a critical aspect of the federal government’s health care takeover. 

Unfortunately, special interest groups will clamor to pressure the Republican leadership at the General Assembly to expand Medicaid under Obamacare. 

Fortunately, the Supreme Court of the United States ruled the Biden-Pelosi-Schumer government in Washington cannot force states to expand Medicaid. The General Assembly has already exercised our state’s rights, rejecting Medicaid expansion and the additional Obamacare empty promises that would come with it, by passing Senate Bill 4 — No NC. Exchange/No Medicaid Expansion — in early 2013. This bill prevented Gov. Roy Cooper from unilaterally expanding Medicaid in his first week in office in 2017.

The General Assembly should continue to ignore calls for Medicaid expansion. 

The Obama administration promised states that Washington would pick up 100% of the expansion costs for the first three years, and then 90% after that — but how reliable is this guarantee from a federal government that is $27 trillion in debt, much of which is due to Medicaid? Moreover, unforeseen costs have been a constant problem for Medicaid.  

For example, Medicaid expansion in Louisiana was expected to cost about $1.4 billion per year. Instead, it has cost taxpayers an estimated $3.1 billion per year — more than twice the Legislative Fiscal Office’s original estimates, according to the Pelican Institute. 

A 2020 study from the John Locke Foundation found that Medicaid expansion in North Carolina would create a significant gap in the state budget. This funding gap of $119.3 million to $171.3 million in the first year alone would have to be made up through new state appropriations, increased taxes on managed care plans, or higher taxes on providers. 

Additionally, renewed calls for Medicaid expansion also come when the state’s Medicaid program continues to transform into a new managed care model, which expansion would confuse and disrupt. 

And what would we be paying for? Nothing that should comfort taxpayers. Potentially crowding out funding for public safety and schools for the return on investment we would receive from Medicaid expansion would be ludicrous. 

Medicaid expansion would inexplicably hurt the most vulnerable North Carolinians. Medicaid is a program meant for the most disadvantaged residents. However, because of Medicaid’s low doctor reimbursement rates, patients already have a tough time getting a doctor’s appointment, contributing to the program’s shockingly poor health outcomes. The expansion would add thousands and thousands of able-bodied, childless, working-age adults to Medicaid, which would further exacerbate the problem of access to quality care for the neediest North Carolinians. 

As former Wisconsin Gov. Scott Walker — who rejected Medicaid eligibility expansion — told the Wall Street Journal, “Caring for the poor isn’t the same thing as taking money from the federal government to lock more people into Medicaid.” 

Obamacare expansion via Medicaid is a shell game that’s a bad deal for taxpayers and a bad deal for North Carolina’s economically disadvantaged families. When special interest groups come knocking after the legislative session starts, the General Assembly should keep the door shut. 

Donald Bryson is the president and chief strategy officer of the John Locke Foundation, a public policy think tank in Raleigh. This piece first appeared in the February print edition of Carolina Journal.