Stretching Medicaid Too Thin
Extending government healthcare to people who don't need it is a bad idea.
Medicaid is unusual in the world of healthcare in that it provides access to comprehensive medical services without substantial cost-sharing or waiting lists. This has only been sustainable because eligibility for the program has been limited to the neediest sections of society, who cannot be expected to contribute anything to the cost of their care.
The expansion of the program to able-bodied childless adults by the Affordable Care Act represented a departure from this guiding principle, and proposals for Medicaid to be expanded to all would cause its ability to maintain these core priorities to collapse. The GOP proposals to shift subsidies for low-income able-bodied adults to the exchange therefore represent a laudable attempt to refocus Medicaid’s assistance on those who need it most.
Medicaid was originally designed to provide essential medical care to individuals who could not be expected to work for reasons of disability, age, or family responsibilities. For this reason, and unlike most other healthcare benefits in the United States, it provided care without requiring any premiums, deductibles, or co-pays from beneficiaries whatsoever. But eliminating the sensitivity of enrollees to prices when visiting physicians, getting tests, selecting drugs, or undergoing procedures, potentially greatly increases the per-enrollee cost of coverage.
Chris Pope is a senior fellow at the Manhattan Institute and author of “How Per-Capita Spending Caps Can Help Advance Equity in Medicaid.”
This piece originally appeared in The American Conservative