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Beyond the Basics: Breaking Down...

Beyond the Basics: Breaking Down Medicaid Expansion

By: Jonathan Bain - August 9, 2023

Jonathan Bain

When a state expands Medicaid, Washington is taking your money and sending it to states across the country so that able-bodied adults can enjoy free welfare benefits.

The blistering heat of the Mississippi summer, the aroma of funnel cake and corndogs wafting through the thick, humid air, combined with ardent political speeches and posturing from candidates from across the spectrum can only mean one thing: the Neshoba County Fair. 

The fair began in the late 1800s, and when then-Governor McLaurin spoke at the fair near the turn of the century, he solidified a tradition that would remain to this day—perhaps stronger than ever. Those already in office, and others who are trying to get a foot in the political door of the state, flock to Philadelphia to spread their message, interact with voters, and gain steam as they head into election season. 

This year, and in the many years prior, Medicaid expansion was a hot topic at the fair. Candidates and incumbents alike threw their support behind the idea or remained steadfast in their staunch opposition to it. But perhaps not everyone reading this fully grasps what Medicaid expansion is, and what it isn’t, or may ask the more general question of: “What is Medicaid expansion, anyway?” Luckily for those readers, I’m here to answer that question to the best of my ability. 

In 2010, then-President Obama’s Affordable Care Act—more commonly known as ObamaCare—became the law of the land. One of the key tenets of President Obama’s proposal was to expand Medicaid to an entirely new class of able-bodied adults—those physically and mentally fit for employment. Why is this worth noting? Because prior to ObamaCare, Medicaid was typically reserved for the truly needy—the elderly, low-income children, pregnant women, and those with mental or physical disabilities. 

In one fell swoop, the Medicaid program was transformed from a program intended to serve the impoverished—to provide a safety net for the truly needy—to a program that provided welfare benefits to able-bodied adults, most of whom had no dependent children. In traditional Medicaid, hopeful applicants must demonstrate need. In Mississippi, for example, having a low income is, in most cases, not enough to qualify for benefits. Applicants must fall into a category of need, where their ability to provide for themselves has been compromised in some way. In every sense of the word, Mississippi’s Medicaid program functions as a helping hand, not a handout. 

But how does Medicaid expansion differ from traditional Medicaid, outside of expanding the pool of eligibility? I’m glad you asked. In expansion states, able-bodied adults that became eligible for Medicaid through ObamaCare only have one qualifying factor: a low income. That’s it. As I type this, I’m a (relatively) healthy 28-year-old man. If Mississippi were to expand Medicaid, I would be eligible for benefits, so long as I keep my income under the eligibility threshold—or even if I had no reportable income at all. I would not be expected to work, search for work, or be actively trying to improve my situation. Medicaid expansion is truly a “don’t ask, don’t tell” policy. This means that bureaucrats don’t want to know anything about me other than my income, because their goal is to enroll as many able-bodied adults as possible. 

In many welfare programs, states have implemented work requirements to ensure that enrollees have skin in the game. The idea is that if you are actively trying to provide for yourself, taxpayers are willing to lend a helping hand to make it easier for you. The end goal is a full transition from welfare to work, which should be the goal of all public assistance programs—as self-sufficiency is a core tenet of our belief system as Americans. But these work requirements do not exist in the Medicaid program. During the presidency of Donald Trump, many expansion states submitted waivers seeking to implement work requirements in their expansion programs. Arkansas successfully implemented these work requirements, but it was short-lived. Battles in the courtroom suspended Arkansas’s waiver, and once a new administration moved into the White House, all similar waivers were denied. 

Another question that often surrounds the Medicaid expansion debate is that of money—namely, where does the funding come from? Admittedly, under the current system, the federal government does foot the bill for the bulk of expansion costs a state incurs. This has made the decision to expand easier for some states, as the thought process is typically that federal money is somehow much different from state funds. But is it really? State taxpayers are federal taxpayers. In fact, most of the taxes that you pay go straight to the federal government. When the federal government spends money, they’re spending your money. And when a state expands Medicaid, Washington is taking your money and sending it to states across the country so that able-bodied adults can enjoy free welfare benefits. That hardly seems fair. 

Another problem with the current funding mechanism seems obvious—how long will it last? Once a state expands Medicaid, they’re relying on the word of federal bureaucrats. That seems stable, right? I mean, it’s not like the federal government has ever gone back on its word—has it? Washington D.C. has been termed the “swamp” for a reason. History would tell us that relying on the promises of government bureaucrats is to rely on failure and disappointment. Why should Medicaid expansion prove any different?

This is just the tip of the iceberg but is a good starting point. For those still reading, my opposition to Medicaid expansion is apparent. But that opposition doesn’t distort the facts of what expansion is, and what it isn’t. Hopefully, you’ll join me next time, as we attempt to delve a layer deeper into expansion, and the more glaring problems associated with it. 

About the Author(s)
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Jonathan Bain

Jonathan Bain is a Senior Research Fellow at the Foundation for Government Accountability, where he conducts research on a variety of topics, including: welfare reform, restoring a free-market to health care, cutting red tape and reducing barriers to work, and restoring integrity in elections. Prior to joining FGA, Jonathan spent time as an independent contractor developing a policy research and analysis skill set while finishing his degree. He holds a Bachelor of Arts in Political Science from Mississippi State University.