Reconciled to the Truth: Medicaid Expansion Disappoints

Even before he was elected to the U.S. Senate from Georgia, Rev. Raphael Warnock’s brand was speaking “uncomfortable truths.” When preachers tell the truth, he once told a reporter, “very often it makes people uncomfortable.”

Now that Sen. Warnock is in the Senate and pushing a massive Medicaid expansion in the reconciliation bill, here’s an uncomfortable truth for him: Coverage doesn’t equal care, and Medicaid expansion doesn’t improve health outcomes.

Warnock of Georgia led a contingent of his colleagues in a press conference last week to urge his colleagues to support the expansion of Medicaid in the $5 trillion bill.

“We push for the expansion of Medicaid because that’s what Georgians voted for when they sent me and Jon Ossoff to the Senate,” he said. “And that’s what the American people voted for when they gave us the majority and now we owe it to them to deliver this legislation that will literally help save lives.”

The claim that Medicaid will save lives is a common misconception that has been repeatedly refuted. According to a research study on the matter, “Two of the best designed health coverage studies—the RAND health insurance experiment and the Oregon Medicaid experiment—showed that health insurance expansions produce negligible average effects on health.”

Other speakers at the press conference echoed the sentiment that having insurance coverage was somehow synonymous with receiving health care.

But that’s not what 11 years of the Affordable Care Act (Obamacare) have shown us. Medicaid expansion was a key part of the ACA, but it was made optional. So far, 39 states have opted in—not including Warnock’s home state of Georgia.

The most important metric for evaluating the performance of expanding coverage is mortality. Research has clearly shown that, “At a macro level, there has been a significant coverage expansion since 2013, but on one key metric—mortality—population health has worsened since the implementation of the ACA. Life expectancy declined for three straight years from 2014 to 2017.”

The senators claim they have a national mandate to expand Medicaid, but they fail to recognize that they put a very popular federal Medicare program in jeopardy by funding a non-effective one. American seniors pay into the Medicare program throughout their working career with the hope and expectation that their contribution will have helped to fund a program that will be there for them when they need it.

Yet according to the2021 Medicare Trustee’s Report, the fund is expected to be depleted in less than five years. The trustees end their report with an ominous statement warning Americans that “the financial projections in this report indicate a need for substantial changes to address Medicare’s financial challenges. The sooner solutions are enacted, the more flexible and gradual they can be. The early introduction of reforms increases the time available for affected individuals and organizations—including health care providers, beneficiaries, and taxpayers—to adjust their expectations and behavior. The Trustees recommend that Congress and the executive branch work closely together with a sense of urgency to address these challenges.”

Although these warnings have been sounded for decades, the ability to sustain the program in the face of ever increasing spending and bloated programs such as Medicaid makes it more and more difficult to sustain without increasing taxes on more and more Americans.

There is a reason why 11 states have held out against Medicaid expansion. They’ve seen the results in the other 39 states. Most beneficiaries see no improvement in their care, the mortality rate is going up, the use of the emergency room is increasing for basic primary care issues. At the same time, the number of physicians taking new Medicaid patients is decreasing, and the state health care budgets are increasing and siphoning off resources needed for education and other programs.

One-size-fits-all programs have proven to do more harm than good, and Medicaid expansion is no exception. That’s an uncomfortable truth for the U.S. Senate.