All the reasons to expand Medicaid. All the reasons not to.

Let’s see if we can list all pros and cons for Medicaid expansion we’ve heard articulated. Let’s try to provide links to or about them. I’m making no attempt to exclude reasons that are not supported by evidence. I’m making no attempt to exclude “bad” reasons or include “good” ones. I’m trying to capture them all. We can sort problems out in the comments.

Reasons why states should expand Medicaid

  1. A large proportion of low income individuals are uninsured.
  2. Even some low income people with disabilities don’t qualify for Medicaid.
  3. Medicaid is good for health (more here).
  4. Medicaid offers financial protection.
  5. Expansion costs states very little; most of the cost is covered by the federal government.
  6. More broadly, health reform saves many states money.
  7. Medicaid expansion supports the economy.
  8. Medicaid addresses the uncompensated care problem.
  9. Politically powerful interest groups (health care providers among them) support expansion.
  10. It would reduce cost shifting.
  11. Expansion supports the broader reform, helping to legitimize it and make it function better. It’s good for Democrats in November.
  12. Providing access to affordable coverage, as well as people taking up that coverage, is our moral duty.

Reasons why states should not expand Medicaid

  1. The uninsured already have access to necessary health care, even for free.
  2. Medicaid harms health.
  3. Expansion is expensive for states.
  4. Moreover, populations currently eligible for but not enrolled in Medicaid will come out of the woodwork. [I fail to see how this is an argument against expansion, but it works in concert with number 10 below.]
  5. Expansion is expensive in general, as is health reform. The money should be used in other ways.
  6. Medicaid is part of the welfare state that promotes social dysfunction. (See also, this.)
  7. States can extract concessions from the federal government in exchange for expansion, so it is rational to resist until the terms are right.
  8. Republican electoral constituencies do not, on average, benefit from expansion.
  9. Medicaid should be block granted; states should be afforded greater flexibility.
  10. Resisting expansion undermines reform, which is good for Republicans in November.
  11. Medicaid reduces the incentive to work.
  12. Medicaid expansion crowds out private coverage.
  13. The expansion comes with cost-increasing coverage mandates.
  14. Medicaid expansion will exacerbate the effects of a shortage of primary care physicians.

Which of these above — whether pro or con — strike you as good reasons? Which are supported by sound evidence? Have I forgotten any (either reasons or evidence)?


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