North Carolina and other states that refuse federal money for Medicaid expansion are cutting the deficit, not sending money to other states, three officials from a conservative think tank argue in a recent Forbes.com article.
“Politicians have made the case for Obamacare’s Medicaid expansion based on the false idea that rejecting Medicaid expansion will send their states’ shares of Obamacare money to other states,” says an article written by three staffers from the Florida-based Foundation for Government Accountability, a nonprofit that promotes free market solutions and opposes “failed health and welfare programs.”
The question of subsidizing other states has been debated since Republican leaders in the Carolinas and 21 other states declined to expand Medicaid coverage to their poorest adults, as outlined in the Affordable Care Act. Residents of those states pay the taxes levied to support the act, but receive none of the federal money intended to provide health coverage to the poor.
As McClatchy Washington reporter Tony Pugh and I reported last fall, that comes to $10 billion from N.C. taxpayers by 2022. One Duke professor quoted in that article described the state’s refusal to accept those benefits as “the redistribution of money from poorer states to richer ones, an outcome imposed by the poorer states upon themselves.”
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The Forbes article cites a January memo from the nonpartisan Congressional Research Service saying that the rejection of federal money by non-expansion states doesn’t increase the amount that goes to expansion states.
“It’s simply never spent,” the Forbes article says. “That means those dollars simply are not added to the national debt.”
The Congressional Budget Office pegs this year’s deficit at $486 billion. I have to admit, I can’t get my head around that amount of money, let alone going that much deeper into debt every year. So I understand the drive to rein that spending in.
But my mind also boggles at the idea that North Carolinians who earn less than the federal poverty level are the ones being asked to chip away at our monstrous debt by going without health coverage. The poverty level is $11,760 a year for an individual, about what I made when I got my first reporting job in 1981.
Thirty-four years ago, that was a living wage. Today I can’t imagine trying to cover rent and food on that paycheck, let alone pay medical bills.