Medicaid expansion is a proven loser, so don’t fall for it

The chaos that continues to engulf the health care debate in Washington, D.C.. reaffirms the assertion that states must forge their own paths to protect the most vulnerable people in their communities. But too many states have turned to an expansion of Medicaid through Obamacare as a solution — putting their truly needy at risk and leaving taxpayers with surging costs as a result. Georgia must take a different route.

The opportunity that Georgia now faces can’t be understated: a chance to protect valuable resources for the most vulnerable in our communities while ensuring that our state has funds to provide vital services for generations to come. But to succeed, we must continue to avoid an Obamacare Medicaid expansion.

While Georgia has stood against expansion, most states have gone along with it, including several that initially resisted. Across the nation, Medicaid expansion has flooded state welfare rolls with able-bodied adults at an alarming rate. States that have expanded Medicaid have enrolled 110 percent more adults than ever expected, creating a new welfare class of able-bodied, childless adults who are dependent on the government.

The result? A fiscal crisis that looms over states’ budgets, eating away at funds necessary for education, public safety and infrastructure. States’ revenues simply cannot keep up with the rising Medicaid costs, so policymakers saddle taxpayers with the debt.

As the number of able-bodied enrollees rises, cost overruns will continue to devour state budgets. Just consider Indiana, where expansion ran $285 million over budget in the first 11 months of the program, or Ohio, where lawmakers are considering slashing payments to pediatric hospitals to fund the state’s expansion program. Georgia cannot afford to follow these states.

Beyond being fiscally irresponsible, Obamacare Medicaid expansion is immoral — and it threatens our most vulnerable neighbors. Its perverse funding structure incentivizes states to siphon resources away from the truly needy to help pay for the cost overruns.


Nationwide, over 600,000 truly needy individuals are trapped on Medicaid waiting lists as state governments continue to extend benefits to able-bodied adults. Thousands of children and adults with development disabilities are languishing on waiting lists, often getting pushed to the back of the line to make way for new expansion enrollees. These expansions of Medicaid under Obamacare are destroying and perverting the original mission of Medicaid.

One need only look to Arkansas for a cautionary tale of Obamacare expansion. Originally billed as a fiscally conservative alternative to standard expansion, Arkansas’ “Private Option” expansion has proved to be simply a more expensive way to expand welfare.

A combination of soaring enrollment and rising costs has put additional pressure on other spending priorities, and has left few resources for the truly needy in the state. Though Arkansas lawmakers originally promised that only 215,000 able-bodied adults would enroll, the number of able-bodied enrollees had surged to nearly 325,000 adults by September 2016, resulting in $80 million in cost overruns, according to a recent study.

But in Arkansas — as across the nation — expansion has hurt the truly needy the most. More than 700 disabled children and adults have been added to the state’s Medicaid waiting list. Thousands more are at risk of losing care and the resources that they desperately need as benefits continue to go to able-bodied adults.

To expand Medicaid under Obamacare would put vulnerable Georgians at risk. It would be a blatant deception toward the taxpayers in our state who work hard for the money they earn and deserve to receive quality public services. It would enable able-bodied adults to fall into the welfare trap and begin a lifetime of government dependency.

Now, in an effort to exploit the political chaos in Washington, powerful interest groups in Georgia are lining up to urge the state Legislature to journey down this treacherous fiscal path, while touting Medicaid waivers as a way forward. Such interest groups will be calling for addition of “work requirements” to the Medicaid expansion waivers in order to pass them off as “conservative versions” of Medicaid, while loading the state’s Medicaid rolls with able-bodied adults who would not qualify as traditional Medicaid recipients like the deaf, blind or disabled.

In a recent legislative study committee meeting addressing the topic of access to health care in rural Georgia, it was noted that “80 percent of rural hospital income comes from the government,” yet rural hospitals are still having problems staying open. This dynamic illustrates that rural Georgia essentially has a “single-payer” health care system in which the dominant payer for services is government.

As one who is intimately acquainted with this system through my medical work, I know that Medicaid expansion will only exacerbate the crisis of access to care in the most vulnerable populations and regions of our state. Simply throwing more money at this problem offers no real solution, just a clever welfare trap.

Nationwide, Medicaid expansion has been a massive policy failure, but we cannot forget that policy always has a human face. Children and adults continue to suffer every day as a result of this legislation, and we must not make the mistake of putting that same suffering on the people of Georgia. We must protect our state from the disasters of Obamacare expansion.

State Rep. Jason Spencer (R-Woodbine) represents House District 180, which includes Camden, Charlton and Ware counties, and he is also a board-certified physician assistant (PA-C) practicing critical access emergency medicine in various small rural hospitals in South Georgia.