Josiah Bartlett Center - On Medicaid Expansion: Rhetoric isn't Reality

A central focus of the budget conference committee has been whether or not the state should expand Medicaid. I think the disagreement is not well understood by either side nor are the likely outcomes. This short piece is an attempt to point out the real difference of opinion:


The current debate over Medicaid expansion is misleading simply because the expansion doesn’t do what supporters think it does. Experience shows that it does almost the opposite of what they intend: it doesn’t affect the uninsured and doesn’t reduce uncompensated care costs that are passed on to those with private insurance. The experience of two neighboring states, Maine and New Hampshire, should be studied.


Supporters of Medicaid expansion truly don’t understand how anyone might possibly oppose expansion. In their mind, it must be politics. They sincerely believe that an expansion would simply shift people who currently don’t have insurance into the Medicaid program covering more people and reducing the uncompensated health costs that are passed on to those with private insurance.


Those of us who are skeptical to some degree or another about expansion look to the experience other states have. We believe that the number of uninsured won’t decrease at all, people will be shifted from private insurance to Medicaid, and that uncompensated costs we must subsidize will increase not decrease. We believe this because of experience....

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