North Dakotans should be uncomfortable with the proposed expansion of Medicaid.
The federal government offers between $100 million and $150 million during the 2013-15 biennium to insure 20,000 to 30,000 additional residents, mostly adults. It would cost the state more than $300,000 to administer the program.
While North Dakota can afford its share, the federal government already has a nearly $17 trillion debt and can ill afford to add to it. Further, this is within the context of a vigorous North Dakota economy with as close to full employment as is possible, less than 3 percent unemployed.
What percentage of North Dakotans ought to be dependent on government for health insurance? Presently, 66,322 North Dakotans are enrolled in Medicaid, or about 9 percent of the state’s population. Add covering 20,000 adults to that number, and the percentage enrolled in Medicaid rises to 12 percent of the population.
In testimony before the House Human Resources Committee recently, the case was not made for an urgent need for the coverage. And if that case should be made in the future, the state is in financial position to act. Rep. Al Carlson, R-Fargo, suggests block grants, and that should be explored.
Also, the consequences of accepting that money would go beyond 2015. The federal government sets up programs like this, begins to fund them and then requires the state to pick up the costs. In the future, the state could be on the line for countless millions. North Dakota may be flush now, but history suggests that might not always be the case.
The expansion of Medicaid is part of the Affordable Care Act. When the country looked at reforming health care, one of the primary motivations was to control costs. Heath care costs have been increasing much faster than the rate of inflation, taking larger and larger bites out of family budgets. But the Affordable Care Act did not contain effective measures to control costs. Rather, it shifts the burden of those costs to state and federal governments.
If North Dakota accepts the expansion of Medicaid, those funds go right to the federal obligation, in other words, pushing the federal debt even higher. People sympathetic to those 20,000 or 30,000 North Dakotans who might qualify for expanded Medicaid might find this a painful truth, for these are our friends and neighbors.
However, most North Dakotans also understand the need to deal with the federal government’s growing debt. These are uncomfortable choices for all. We should not talk fiscal conservatism in North Dakota and then continue to accept increased federal payments at the expense of the federal debt.