Why Disliking Medicaid Expansion Makes Me the Good Guy

Uncontroversial: Let’s give poor people access to health care!

Controversial: Medicaid sucks.

Why the dissonance?

An important facet of the current Affordable Care Act (or “Obamacare”) discussion is whether states will implement Medicaid expansion, thus offering more extensive government provided health care to the poor. Medicaid eligibility will include about 16 million more people and cost about $100 billion more annually by 2020, according to the Cato Insititute.

The battle cry from the left is that the poor need access. The response from the right is that Medicaid is too volatile to expand. Both sides are correct on those basic points. What most commentators miss, though, is that we can and should help the economically disadvantaged, by moving away from Medicaid.

The question now is, what’s the alternative? The often mocked answer is lessening government involvement to let the market work. While states that opt out of the expansion will not receive extra federal funding, they do have the opportunity to accommodate markets for health care that is actually affordable.

The ACA seeks to offer Medicaid to those with incomes decently above the poverty line because government health care mandates for services most people will never use drive up costs, making it so that more people have cause to use Medicaid. States that reject expansion gain the flexibility to reduce their own mandates in order for competition between private insurers to drive down plan costs.

Moreover, with more access to private services, the currently uninsured will actually receive care. According to the New England Journal of Medicine, doctors are far more likely to accept new non-Medicaid patients; actually, doctors are more likely to accept uninsured patients than those on Medicaid at this point. And in the rural areas where many current and potential Medicaid patients live, physicians are already scarce, thus limiting the chances of finding a doctor to provide treatment.

Despite what detractors claim, the market has not already been functioning only to fail. 80% of the nation has inadequate access to competitive health care, in part due to bans on interstate commerce for insurance.

This incredibly problematic structure has disenfranchised people from getting to choose plans that provide the services they need. Only by denying the government so much power over how people get treatment can people begin to find what the government promised: Affordable and individualized health plans.

Rejecting Medicaid expansion is not motivated by heartlessness or, to use Paul Krugman’s word, spite. It’s about empowering those who need help and whom we have largely left out of this conversation.

We should have learned cannot blindly throw government money at problems and hope they go away. Trying that led Ronald Reagan to say, “We fought a war on poverty and poverty won.” We need to be realistic about how to improve our health care system regardless of partisanship. And, ultimately, we need the ideologues to step back so we can all move forward.


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