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Daily Journal: Are we willing to accept cost of expanding Medicaid?

Becki Gray writes for Carolina Journal’s Daily Journal:

The governor’s behind it, and state Department of Health and Human Services Secretary Mandy Cohen is for it. Some freshmen legislators have made it a priority, some leaders in the N.C. House think it’s a good idea, and 32 states have implemented a version of it.

But does Medicaid expansion take us in the wrong direction?

We begin the 2019 legislative session with winds of transformational reforms at our backs. They’ve given us surplus revenue, more transparency, more opportunities, and a stronger economy.  Do we really want more government control over health care?

Medicaid is federal- and state-run health coverage designed for vulnerable and high-risk, low-income aging and disabled adults, pregnant women, and children. Twenty percent of North Carolinians are covered under Medicaid. State taxpayers foot about a third of the total costs of $3.6 billion. Medicaid is 16 percent and the fastest growing part of the general fund budget. A provision in Obamacare authorized states to expand Medicaid coverage to low-income, able-bodied childless adults with an income of $16,753, or for a family of four to $34,638. Thirty-two states have expanded Medicaid, but North Carolina isn’t among them.

The federal government has promised to pay 90 percent of the costs for Medicaid expansion through 2020. But that doesn’t apply to administrative costs, and future funding isn’t guaranteed. The federal government is already $22 trillion in debt. In states that expanded Medicaid, the number of enrollees has been larger than anticipated, and costs have been higher. Lower reimbursement rates have meant fewer doctors willing to take on Medicaid patients, limiting access and compromising outcomes for those receiving care through Medicaid. The General Assembly’s nonpartisan Fiscal Research staff estimates initial Medicaid expansion will cost about $300 million.

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