There’s an old maxim in American politics, usually attributed to former U.S. Senator and Nixon administration cabinet secretary Daniel Patrick Moynihan, that “Everyone is entitled to their own opinion, but not to their own facts.” Would that Moynihan were still alive today so that he could direct a reminder of this simple truth toward North Carolina Senate President Pro Tem Phil Berger.
Berger, as you are no doubt aware, has embraced the role of a kind of 21stCentury “Senator ‘No’” who tries to place himself squarely in the way of societal progress on issue after issue. Recently, in an apparent effort to further cement this moniker, Berger (or, presumably, his staff – and maybe even a junior intern judging by the quality of the claims) took to Twitter to rehash several tired and long discredited claims about the increasingly popular and bipartisan idea of expanding Medicaid in North Carolina.
According to Senator Berger, “Obamacare Medicaid expansion” is “wrong for North Carolina” for six reasons:
- it will harm current Medicaid enrollees by forcing them to “compete” for care with those who are added to the program;
- it is “immoral” because it would supposedly place new enrollees ahead of 12,000 disabled North Carolinians currently on the Medicaid waiting list;
- it will cost too much and be unsustainable;
- the program is already overburdened;
- it will create new jobs, but only at the expense of higher taxes, lower wages and higher health insurance premiums; and
- it will not improve health outcomes for those who gain coverage.
Here are the actual facts:
#1 – Refusing to expand Medicaid because it will somehow bring about a problematic competition between new and existing enrollees makes absolutely no sense. Indeed, Berger should try explaining this claim to the rural health care providers and low income residents in his own district who are demanding expansion. Sure, there will be growing pains that will accompany expansion, but it remains undeniable that expansion will bring billions of dollars into the state that will, in turn, fund more and better services from hundreds of health care providers.
#2 – It’s hard to know whether to laugh or cry at Berger’s protestations about the supposed immorality of expansion – especially when he already possesses the power to end any existing waiting lists that might exist for the program. Perhaps the Senator needs to be reminded of what Ohio’s Republican governor John Kasich said about expansion back in 2013: “Now, when you die and get to the meeting with St. Peter, he’s probably not going to ask you much about what you did about keeping government small. But he is going to ask you what you did for the poor. You better have a good answer.”
#3 – Refusing to expand Medicaid because the federal government pays only 90% of the freight and could conceivably reduce that share someday makes about as much sense as not having a family because one’s employer might someday take larger deductions from one’s paycheck. And how come Berger never makes such arguments with respect to accepting federal assistance for countless other public initiatives like, say, highways, in which the federal reimbursement rate is much lower? If he’s truly worried, Berger need only make expansion contingent on the feds sticking to their 90% reimbursement rate.
#4 – As with #1, the claim that the Medicaid provider system is already “stretched” and therefore can’t be expanded is a true head-slapper. Earth to Senator Berger: listen to rural providers in North Carolina and see what they say about how Medicaid expansion would dramatically improve their financial viability and ability to serve people in desperate need of care (many of whom they’re already serving without any reimbursement).
#5 – Berger does not deny that Medicaid expansion will create large numbers of new health industry jobs and his attempt at a critique – that this will only occur as a result of higher taxes, reduced wages and higher health insurance premiums – has been debunked repeatedly. As a 2018 article in Forbesmagazine citing a University of Montana study noted, expansion has been a win-win for the economies and state budgets of most states, without tax increases.
#6 – Berger’s claim that expansion will not improve health outcomes may be his most preposterous. By such “logic,” Medicaid itself – the same system that he so badly wants to bring to 12,000 people with disabilities – shouldn’t even exist in the first place. Researcher Rachel West put it this way in an October 2018 report:
Overwhelming evidence shows how Medicaid expansion…has substantially increased health insurance coverage and improved access to affordable care….A growing body of research also shows that Medicaid expansion’s benefits extend far beyond coverage and access to care: It also saves lives, reduces families’ chances of facing bankruptcy, and increases access to opioid addiction treatment, among other benefits.”
The bottom line: If Senator Berger truly believes that insurance coverage doesn’t improve health outcomes, he should do the obvious thing and cancel his own publicly-funded coverage. Let us know how that goes, Senator.