Why States Should Not Expand Medicaid

States that have resisted expanding their Medicaid programs have witnessed the soaring costs in other states and the adverse impact on vulnerable patients who must compete for providers with expansion enrollees. 
As legislators prepare for their upcoming sessions, the Galen Institute and the Foundation for Government Accountability (FGA) have partnered in offering guidance for states based upon experience and research documenting problems with expansion.
Sam Adolphsen of FGA and Brian Blase and Grace-Marie Turner of Galen worked together in preparing “Why states should not expand Medicaid,” a new version of a paper we originally published soon after the Supreme Court decision gave states the option.  Our warnings then have proven predictive today. 

Although the allure of federal money has led too many states to adopt expansion, doing so will worsen the safety net program for the truly needy, lead many people to replace private coverage with public coverage, will significantly increase state expenditures, will crowd out other vital priorities, and will worsen federal budget deficits, the paper explains. 
States should continue to press Washington for greater flexibility to best manage their programs and resist the ACA’s failed Medicaid expansion.
We offer and explain 12 reasons states should resist Medicaid expansion and instead develop alternative programs tailored to their states:
  1. Medicaid expansion harms the truly needy
  2. State spending will explode, crowding out other priorities
  3. Waste, fraud, abuse and misspending will skyrocket
  4. Expansion crowds out private coverage
  5. Access to timely and proper care will worsen
  6. Expansion causes emergency room use to surge, and hospital capacity to deteriorate
  7. Expansion not associated with improved health outcomes overall
  8. Expansion enriches health insurance companies
  9. States’ finances will be more vulnerable to federal law changes
  10. Refusing to expand saves taxpayer dollars and reduces federal deficits
  11. There are many good healthcare options available already
  12. Targeted initiatives have better results than Medicaid expansion
Click to Read the full paper

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