Guest opinion: Actually, we can afford Medicaid expansion

Opponents of Utah’s Proposition 3 to expand Medicaid — which the majority of voters supported — often claim that expanding Medicaid for low-income Utahns will wreck our state budget. They use this claim to justify proposals to impose caps on enrollment, to delay expansion, to impose work requirements or to roll-back expansion completely.

Despite this worn-out “we can’t afford it” claim, we now have the experience from other states’ Medicaid expansions to more accurately predict what will happen in Utah. As your elected officials, we must consider the best data available when making policy decisions. We now have data from credible sources on how Medicaid expansion has actually impacted other states.

Here is what the experience from other states tells us, and why our colleagues need to allow Medicaid expansion to proceed.

States that expand Medicaid see broad economic benefits associated with the expansion. Expansion states have experienced economic growth from increased employment and spending in health care and other economic sectors, such as construction and retail services. Since Louisiana’s 2016 expansion, it has seen a $1.85 billion direct economic impact and created 19,000 new jobs. A conservative estimate for Utah is $800 million annually in new spending if Medicaid expansion moves forward.

Opponents to Medicaid expansion regularly overstate the negative impact on states’ budgets. In fact, expansion states have been able to reduce spending on mental health and correctional health services and reduce the burden on hospitals for uncompensated care. Michigan expects to see net savings from expansion total more than $1 billion from 2018-2021 due to increased tax revenue and savings on state mental health programs. Virginia, which approved expansion last year, is projected to save the commonwealth $421 million in its first two years, and is investing the savings into public education.

Even as the federal share of expansion drops to 90 percent in coming years, some states estimate savings will offset much of their expansion costs, while others expect the expansion will continue producing net budget savings.

Opponents claim that Medicaid expansion will force states to cut funding from other budget priorities like education. But the National Association of State Budget Officers found that between fiscal years 2010-2015, states that expanded Medicaid under the ACA saw no significant increases in state spending, nor significant reductions in spending on education or other programs.

Imposing a work requirement for Medicaid, as some propose, sounds like a good idea on the surface. But this actually increases administrative red tape and will cost more than it will ever save. Most importantly, it would further delay implementation because it would require a federal waiver.

Most Medicaid enrollees who can work are already working. Only a small share of people, 6 percent, currently don’t work and would likely meet an exemption because many are full-time caregivers for ill or disabled family members. Multiple studies show that many poor people would lose coverage and would be hurt. Work requirements specifically harm women, children and people with disabilities.

Much of the fear some have about Medicaid expansion is that undeserving people may try to mooch off the system. These fears are unfounded. Nationally, most adults are on Medicaid less than three years. Medicaid is a resource to bridge gaps in coverage, not a lifetime health insurance plan. It functions to get people healthy, so they can work and ultimately secure a job with employer-sponsored health care.

Ultimately, Proposition 3 passed because most Utahns support raising their taxes to give 150,000 low-income Utahns the health care they need. Now with analyses from other expansion states to learn from, the best evidence tells us that Medicaid expansion will greatly improve access and quality to health care, and importantly — that we can afford it. We as legislators should listen to what most Utahns have told us and allow Medicaid expansion to proceed.

CREDIT: Suzanne Harrison and Jennifer Dailey-Provost, Deseret News