Medicaid Expansion, Polarization, and Diving Head-First Into the Unknown

I have always believed in the concept to think first, act second. I rarely react; I try to act. In politics, generally, this mantra is not followed. If a public poll states that the public is in favor of X, then the leaders need to consider X. If it is an election year, then the politicians will do X.

I’m reminded of an awful book I read a couple of years ago. I can’t remember the name of it, but it began with a young teen-age couple at a lake. The boyfriend dives off of a dock into the lake and dies because his head hit a rock underneath the water. (I do not suggest reading the book). But I remember thinking… “How tragic,” then… “Why in the world would this guy dive head-first into a lake without knowing the depth or pitfalls? This was a preventable death.”

This is a perfect example of why we should think first, act second.

However, in politics, the polarization of the two parties, Republican and Democrat, sometimes causes politicians to RE-act according to the party lines. Nowhere is this polarization more prevalent than the concept of Medicaid expansion. See my blog: “To Expand, Or Not To Expand, A Nationwide Draw?” It seems that if a state has a Republican governor, without question, that state will refuse to expand (I know there are few exceptions, but there are few). If a state elected a Democratic governor, then the state has elected to expand Medicaid.

Are these issues so black and white? Or have we become so politically polarized that true intellect and research no longer matters? Doesn’t that actual state of the state matter in deciding to expand?

For example, according to a 50-state survey by USA Today, North Dakota is the best run state. North Dakota has zero budget deficit, and an unemployment rate of 3.1%, the lowest of all 50 states. North Dakota has opted to expand Medicaid.

On the other hand, according to the same study, North Carolina has an unemployment rate of 9.5%, which is the 4th highest in the nation. What does high unemployment mean? A large number of Medicaid recipients.

North Dakota has approximately 82,762 Medicaid recipients, according to the Kaiser Foundation for FYE 2010. Conversely, North Carolina, for the same year, had 1,813,298 Medicaid recipients.

So my question is: Can, or should, a state with 1.8 million Medicaid recipients adopt the same Medicaid eligibility rules as a state with 82,000 Medicaid recipients?

And how can we know the consequences of expansion prior to deciding to expand? Because, after all, shouldn’t we think first, act second? Who wants to dive into an unknown lake?

But issues that apparently no one had contemplated are cropping up…

States across America are seeing unexpected Medicaid costs increase. According to the Associated Press, prior to Medicaid expansion there were millions of Americans who were eligible for Medicaid but who, for whatever reason, had never signed up. Now that there has been so much publicity about health care, those former un-insured but Medicaid-eligible people are signing up in droves.

In California, State officials say about 300,000 more already-eligible Californians are expected to enroll than was estimated last fall.  See article.

Rhode Island has enrolled 5000-6000 more than its officials expected. In Washington State, people who were previously eligible represent about one-third of new Medicaid enrollments, roughly 165,000 out of a total of nearly 483,000.

While the Feds are picking up the costs for Medicaid recipients now eligible because of the expansion (at least for a few years), state budgets have to cover these new Medicaid recipients signing up who had been eligible in the past.

For states blue or red, the burden of these unanticipated increased costs will be on the shoulders of the states (with federal contribution).

Going back to the extremely polarized view of Medicaid expansion (Democrats expanding and Republicans not expanding)…maybe it’s not all black and white. Maybe we should shed our elephant or donkey skins and actually research our own states. How many Medicaid recipients do we have? What does our budget cover now?

Maybe we should research the consequences before diving in the lake.

About kemanuel

Medicare and Medicaid Regulatory Compliance Litigator

Posted on May 29, 2014, in Administrative Costs, Budget, California Medicaid, Division of Medical Assistance, Eligibilty, Federal Law, Health Care Providers and Services, Increase in Medicaid Spending, Legislation, Medicaid, Medicaid Budget, Medicaid Eligibility, Medicaid Expansion, Medicaid Providers, Medicaid Recipients, Medicaid Reform, Medicaid Services, Medicaid Spending, NC, NC DHHS, North Carolina, Obamacare, Rhode Island Medicaid, Uninsured and tagged , , , , , , , , , , , , , , . Bookmark the permalink. 6 Comments.

  1. Don’t begin vast programs with half-vast ideas.

    Arguably, NC Medicaid is already a vast program, which appears to have been beyond the state’s ability to manage effectively. Surely making NC Medicaid a much larger program would solve all of the existing problems. (sarc off)

  2. Knicole: I agree that states should evaluate their specific circumstances before electing to expand Medicaid. But I think the verb tense is wrong. North Carolina should HAVE already evaluated the expansion of Medicaid. Its not like this decision snuck up on the governor and the legislature. How many years ago was the Affordable Care Act passed with the Medicaid expansion provision. It certainly was not yesterday. It is disingenuous for House Leader Thom Tillis to kick this can down the road for more study.

    • Arguably, it was Governor Perdue and The previous legislature which “kicked the can down the road”. This Governor and legislature should have been expected to study this Medicaid expansion for themselves, rather than accepting any study done under Perdue. This Governor and legislature would also be very wise to resolve the outstanding issues with the current program before dramatically expanding it.

  3. NCTracks is such an abysmal failure that any restrictions of funds for the Medicaid system in NC is a no brainer. The funds they have are not being administered appropriately. And while I look forward to each and every one of your blog posts, enjoying your flair and insight, the April NC unemployment rate was 6.2% in April, right? For the record, before I jump to the bottom of a waterfall, I watch a few other people first, and jump right where they jump and survive. I never do a great job of researching how deep the water is and our elected officials never will either.

  1. Pingback: As the 31st State Expands Medicaid: Do We Need to Be Concerned About a Physician Shortage? | medicaidlaw-nc

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