ObamaCare’s Medicaid expansion has devolved into a fiscal nightmare. Nationwide, more than twice as many able-bodied adults have enrolled in the Medicaid expansion than ever expected. In some states, they’ve enrolled more adults than thought to even be eligible, leaving taxpayers holding the bag. While Congress continues to debate the details and timing of repealing ObamaCare, states are clamoring for options to start rolling back expansion.
The House Energy and Commerce Committee is already considering freezing Medicaid expansion enrollment as a core component of its plan to repeal and replace ObamaCare. As they move forward, new estimates from the Foundation for Government Accountability could provide important insight into how just how much taxpayers could save if Congress gets this right.
Without a doubt, ObamaCare Medicaid expansion costs are out of control. In California, ObamaCare expansion ran nearly $15 billion over budget in just the first 18 months. In Ohio, overruns have topped $5 billion so far and are on track to hit $8 billion by the end of this year. And Illinois’ overruns now exceed $3 billion, showing no signs of slowing down. With no options to control enrollment, taxpayers are left signing blank checks for exploding costs.
But this isn’t just a fiscal problem – this is a moral crisis as well. The cost overruns mean even less funding for services to seniors, poor children, and individuals with disabilities – not to mention other budget priorities like education and public safety.
ObamaCare is already making welfare for able-bodied adults a higher priority than funding for the truly needy, creating a perverse incentive for states to prioritize expansion’s new class of able-bodied adults over services for the truly vulnerable, served by traditional Medicaid.
Nearly 600,000 children and adults with developmental disabilities, severe mental illnesses, traumatic brain injuries, and other serious conditions remain on Medicaid waiting lists for needed home and community-based services. Some of them have waited for decades and many will die before they ever get the care they need.
In fact, since Illinois expanded Medicaid under ObamaCare, more than 750 individuals with developmental disabilities have died while on waiting lists for needed Medicaid services. Something must be done – and quickly – to refocus the nation’s safety net on those who truly need help.
The good news is that there is a simple solution and one that would immediately begin to prioritize the truly needy once again – an enrollment freeze. Under this approach, no new applications for ObamaCare’s Medicaid expansion would be approved, but those already enrolled would be allowed to stay in the program until their situations improved and they became ineligible or until the end of a transition period.
This wind-down approach has worked before. Arizona and Maine closed off new enrollment in earlier expansions after facing massive cost overruns. In Arizona, more than 70 percent of these enrollees cycled off the program within just two and a half years. No one was thrown off the program overnight. They gradually left on their own.
And in Maine, more than half of the enrollees left the program over the course of 18 months.
Based on these past freezes, a nationwide ObamaCare expansion freeze could reduce enrollment by nearly 45 percent in just the first year. By the end of the second year, just two in five of those currently enrolled would still be on the program. Enrollment would continue to drop until the end of the transition period.
These enrollment reductions would naturally produce significant savings for taxpayers. Data from the Centers for Medicare and Medicaid Services indicates that Medicaid expansion will cost federal taxpayers more than $800 billion over the next ten years. A commonsense enrollment freeze could reduce that cost by $557 billion. That’s more than half a trillion dollars in savings, all of which would otherwise be added to the national debt.
Even better, states would save an additional $59 billion during that same period, for a total of more than $600 billion in taxpayer savings, immediately freeing up public resources for the truly needy.
Finally, while fiscal and moral concerns should trump politics, rolling back ObamaCare expansion through an enrollment freeze would also provide practical benefits for policymakers. It would give Republican governors who inherited ObamaCare expansions a tool to gradually roll back the bad policy choices of their predecessors without creating chaos.
This would help distill any concerns that may exist about creating party discord – because not a single Republican governor who expanded ObamaCare will still be in office at the end of the current gubernatorial election cycle. National and state-level surveys also show that voters favor freezing enrollment by nearly two-to-one margins, making it an incredible combination of good policy, good budgeting, and good politics.
Congress should freeze Medicaid expansion enrollment immediately, before the ObamaCare nightmare gets even worse.
Jonathan Ingram is vice president of research at the Foundation for Government Accountability, a non-profit research organization dedicated to replacing failed health and welfare programs nationwide.
The views expressed by contributors are their own and are not the views of The Hill.