Look closely at arguments against Medicaid expansion

Expanding Medicaid is popular, so popular that Gov. Paul LePage, who strongly opposes government involvement in health care, has tried to appear interested in doing it. (His proposal includes elements counter to federal law and therefore can’t be accepted.)

Passed 48 years ago, the federal government and the states share in Medicaid’s financing. But the Supreme Court decision that upheld Obamacare’s constitutionality let states decide whether to expand it.

People are still pretty divided about the Affordable Care Act, which includes Medicaid expansion.

But more Medicaid — which would enable hard-working low-income people to get health coverage — is quite popular. Nationally, 71 percent want more people to get health care through Medicaid.

Of course, just because a policy is popular doesn’t mean it’s the right approach. And we should take opponents’ arguments seriously, examining them to see if they’re right.

So look at the claims made by a group that’s well-connected to LePage, the Maine Heritage Policy Center.

MHPC criticized Medicaid expansion by purportedly debunking certain “myths.”

Its logic and evidence don’t pass scrutiny.

Its first “myth” concerns the use of federal funds: “The Medicaid Expansion is largely funded by free federal money for state governments.”

Now, “free federal money” is a term meant to evoke an emotional response. But, putting wording aside, one wonders why this is a myth.

After all, the federal government will completely fund Medicaid expansion for three years, with the share falling to 90 percent by 2019.

MHPC doesn’t question that but claims the cost of Obamacare — not Medicaid expansion — is more than earlier estimated.

But if you check the evidence cited, a Congressional Budget Office report, you find its new estimate for 2012-2021 is “$50 billion less than the agencies’ March 2011 estimate for that 10-year period.”

A later 10-year period has more costs than an earlier 10-year period because it takes time for the program to actually enroll people. But when comparing the same time period, the report says it will cost less — not more — than first estimated.

A second “myth” involves Mainers’ federal taxpayers subsidizing Medicaid expansion in other states.

But this is, quite obviously, no myth.

In New Jersey, 395,000 people will join Medicaid, per Republican Gov. Chris Christie’s decision. Thus “New Jersey will receive $1.1 billion in federal funds for the expansion, which will create about 14,500 jobs across all sectors of the economy.” All federal taxpayers bear those costs, but only New Jerseyans will benefit.

The third “myth” is that bringing new people into the Medicaid program would not help them. The MHPC claims, “Medicaid is a troubled program that often harms the poor.”

Now, how could taking people without health coverage and bringing them into Medicaid harm them?

Well, since MHPC doesn’t compare outcomes for people with no coverage to people who gain coverage under Medicaid, the MHPC never shows it does.

And, in contrast, a major study published last year in the New England Journal of Medicine found that Medicaid expansion saves lives and improves health.

The study found fewer deaths among “older adults, non-whites, and residents of poorer counties. Expansions also were associated with increased Medicaid coverage, decreased uninsurance, decreased rates of deferring care due to costs, and increased rates of ‘excellent’ or ‘very good’ self-reported health.”

These gains, denied by MHPC, are extraordinary, since people newly on Medicaid are different from people who have had private insurance. They’ve had less preventive care, more physically taxing jobs and more health issues.

Finally, the MHPC claims that past Medicaid expansions didn’t hold down the number of uninsured, nor decrease uncompensated health care costs.

But the MHPC never compares states that expanded Medicaid to ones that didn’t. That comparison shows that Maine’s prior Medicaid expansion was quite successful.

By 2010, nationally the ranks of the uninsured had soared, up to 22 percent among non-elderly adults in 2010 — even as Maine’s dropped a bit — to 11 percent.

In 2014, uncompensated care will drop everywhere, as health insurance exchanges, more clinics and expanded Medicaid roll out.

No program is perfect. But, as a recent study shows, via Medicaid expansion, Maine would gain 3,100 jobs and $350 million in economic activity. Almost 70,000 working people with low incomes — more than the number who live in our biggest city but spread all over the state — will live longer, healthier lives.

Amy Fried

About Amy Fried

Amy Fried loves Maine's sense of community and the wonderful mix of culture and outdoor recreation. She loves politics in three ways: as an analytical political scientist, a devoted political junkie and a citizen who believes politics matters for people's lives. Fried is Professor of Political Science at the University of Maine. Her views do not reflect those of her employer or any group to which she belongs.