In between pleas for us to wash our hands, stock up on supplies and — above all — not panic, we’re now being told that the coronavirus outbreak shows that we should unanimously support Medicaid expansion.
The irony of this statement is that the states with the highest incidence of acquiring the infection are those that expanded Medicaid. According to the heat map developed by Johns Hopkins to track the spread of the disease, the United States has done remarkably well in limiting exposure overall (just 1% of global cases confirmed) but the trouble spots seem to lean more towards states that expanded the program.
The Medicaid program was intended to provide coverage to the vulnerable, but increasing the number of people into the program will only exacerbate the strain on a system that is busting at the seams. Able-bodied individuals will most assuredly crowd out the women, children, and elderly for whom the benefit was intended.
According to a 2018 study by the nonprofit Kaiser Family Foundation, roughly 582,000 people were eligible for Medicaid or other public programs in Texas and yet did not enroll. People eligible for this “free” service find only a limited number of doctors accept Medicaid, and patients and providers alike face burdensome rules that make it harder to get medications and see specialists, raising the question of whether patients are gaining value.
Every health care system involves limited resources and — potentially — unlimited demand. That’s even more true in pandemic conditions. As the government-sponsored insurance coverage has proved, coverage does not equal care.
Britain’s already-pressed National Health Service is in danger of buckling under the additional pressure of the coronavirus.
Indeed, if government-sponsored coverage was the panacea its supporters suppose that it is, then China’s monolithic system would have been ready for the outbreak when it started. Instead, China’s healthcare workers are dying of both the infection and fatigue, reports say. Its economy is collapsing, and that economic contagion is spreading.
One argument for Medicaid expansion, which was also used to push for the Affordable Care Act, is that increased coverage will decrease emergency room visits (which are, sensibly, discouraged during outbreaks of infectious diseases). But that’s simply wrong; Medicaid expansion did not reduce ER visits.
Free market innovation, for example, led to the development of telemedicine, an under-utilized but potentially invaluable tool in a pandemic. Other models, such as direct primary care, have also led to helpful innovations such as doctor-visits-by-app.
Government has a role, of course, but it should be as a safety net — not a smothering blanket.
Using the coronavirus to call for a government takeover of our health care system feels like that old Rahm Emanuel saw, “Never let a serious crisis go to waste.”
Let’s remain vigilant (and yes, let’s wash our hands — a lot) and let’s also be realistic. Medicaid expansion is no cure-all for what ails our healthcare system.