Put brakes on Medicaid expansion

By Derek Monson

The 2016 election was a referendum on Obamacare, making repeal of the unpopular law all but certain for President Donald Trump's first 100 days in office. But as the debate in Washington rages on, there's one item that should be at the top of the Obamacare repeal list - Medicaid expansion.

Here in Utah, lawmakers wisely passed on Obamacare's Medicaid expansion, which would have extended Medicaid benefits - typically reserved for kids, the aged and disabled - to a new class of able-bodied, working-age adults without dependents. Utah's legislative leaders, led by Speaker Greg Hughes, should be proud that more Utahns aren't trapped in yet another failed government welfare program.

Other states were not so lucky, as Medicaid expansion efforts across the country have created a fiscal nightmare for policymakers and taxpayers alike. In fact, every expansion state with available data has blown past its initial enrollment estimates - enrolling twice as many adults into Medicaid than it had ever expected.

Obamacare's Medicaid expansion is not just a problem for big blue states like California or New York. Nevada predicted that only 78,000 adults would ever sign up for Medicaid expansion, but current enrollment is at 187,000 and counting. And nearby Montana, which launched its Obamacare Medicaid expansion just last year, exceeded its maximum enrollment in the first five months of the program.

These enrollment explosions mean that there are fewer resources available to help the people who need it most. It also means that states will have to make cuts to public safety, infrastructure or education to pay for expansion. For example, Montana officials recently announced plans to lay off 27 highway patrol officers and delay $144 million in highway projects due to a revenue shortfall.

Luckily, Congress has a chance to reverse course. Ending the Obamacare expansion could mean rolling back the changes that converted Medicaid from a program for the needy to one that would put working-age, able-bodied adults on the path to government dependency. And it would provide relief to states that, unlike Utah, decided to implement Obamacare's Medicaid expansion anyway.

One option for Congress to roll back the Medicaid expansion is an enrollment freeze. This would allow current enrollees to stay in the program until they become ineligible due to income, but it would prevent new enrollment.

Medicaid enrollment freezes have been tested in other states, like Maine and Arizona, with great success. Americans living in poverty will, on average, spend about six months at that income level - and nearly three-quarters of them will exit poverty within four months, according to the Census Bureau. An enrollment freeze would give current enrollees time to find other coverage options as their incomes naturally rise.

Congress should also make it possible for states to preserve their Medicaid programs for the truly needy. One such move could allow states to check Medicaid eligibility more often so that people can't take advantage of the program. Another would be to require work for all able-bodied, working-age adults on Medicaid, much like the TANF cash assistance program does today.

As our own Sen. Orrin Hatch leads Obamacare repeal efforts on Capitol Hill, let's hope that rolling back Medicaid expansion is at the top of his list.

Derek Monson is director of public policy for Sutherland Institute, a conservative think tank that advocates for a free market economy, civil society and community-driven solutions.

Credit: By Derek Monson For the Deseret News