North Carolina taxpayers have paid $8.3 billion to expand Medicaid elsewhere

When the Affordable Care Act took effect in 2014, Leighton Ku helped write a report that described how much North Carolina would lose out on if it declined to expand Medicaid starting in 2016.

The report, funded by the Cone Health Foundation and the Kate B. Reynolds Charitable Trust, presented daunting numbers.


Ned Barnett is the editorial page editor of the Charlotte Observer.

It estimated that holding out on Medicaid expansion would cost North Carolina $21 billion in lost federal funding by 2020, would result in 43,000 fewer jobs and would deny the state $860 million in potential revenue.

At the time, 22 states were refusing to expand. Since then, eight have expanded and 14 are still saying no. To Ku’s chagrin, North Carolina is one of the latter.

This week, five years after his Cassandra-like projection of what would befall a recalcitrant North Carolina, Ku came to Raleigh to once more outline the cost of declining to expand and the benefits of doing so.

But Ku, a professor and director of the Center for Health Policy Research at The George Washington University, knows the numbers are unlikely to change the minds of Republican legislative leaders who are dug in against expansion.

“This is an element that’s sort of frustrating,” he said after a presentation at the State Administrative Building. “They don’t respond to the economic logic.”

Given the losses in dollars and lives ended early for lack of health insurance, the numbers today are even more daunting than in 2014. Ku said expanding Medicaid in 2019 would help 634,000 North Carolinians get Medicaid coverage by 2022.

In the years from 2020 to 2022, expansion would bring in $11.7 billion in federal Medicaid matching funds and stimulate the creation of 37,000 jobs. And over that same period it would increase state revenue by $500 million and local revenue by $100 million.

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The idea of going without those dollars and jobs is bad enough, but Ku has updated his findings to include two powerful statistics.

First, since 2014 North Carolina taxpayers have paid $8.3 billion in federal taxes to support the $347 billion cost of expanding Medicaid in 36 other states and the District of Columbia.

Second, studies comparing mortality rates in states that have expanded and those that have not found that the mortality rate in expansion states dropped slightly.

That mortality gap is expected to grow as more people covered by Medicaid leads to earlier detection of cancers, better treatment of heart disease, high blood pressure and diabetes and access to treatment for opioid addiction.

Reviewing the numbers, it’s clear why Gov. Roy Cooper, a Democrat, vetoed a state budget that didn’t include Medicaid expansion. And it’s equally clear why Republican legislative leaders — primarily Senate leader Phil Berger — won’t agree to expand the health insurance program.

It’s not about limiting state spending, because refusing the federal money comes at an exorbitant cost to the health of North Carolinians and the strength of the state economy.

It is about thwarting the acceptance of President Obama’s signature accomplishment and denying help to those the Republican lawmakers refer to as “able-bodied people.”

Supposedly, those able-bodied people should buy their own health insurance with the bounty from their $12-an-hour jobs.

Ku is careful to say he is not an advocate. He just gathers the numbers and translates what they say. Still, it’s hard to see the message ignored by legislators in holdout states.

“That is the sad thing,” Ku said. “I found (the opposition) is on an ideological basis rather than what’s best for the people of the state.”

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Ned Barnett writes for The News & Observer, Raleigh, N.C.


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