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Expand health care, not government
Nina Owcharenko
Nina Owcharenko is the director of the Heritage Foundations Center for Health Policy Studies. - photo by Photo provided.

It’s official: Indiana has given in and adopted ObamaCare’s Medicaid expansion. Before jumping into the weeds of Indiana’s Medicaid-expansion agreement with the Obama administration, it is important to realize the agreement still fails some basic principles of reform.
First, it adds more people on to the Medicaid rolls, not fewer. The plan puts 350,000 more residents on to the overstretched welfare program. Reform should be grounded in reducing Medicaid dependence, not increasing it.
Second, it requires more government spending, not less. The plan will increase Medicaid spending by having the federal taxpayers pick up 90 percent of the costs. Again, reforms should reduce government spending, not increase or merely shift it.
Third, it makes the road to repeal of ObamaCare harder, not easier. The plan offers the Obama administration another big gain in expanding ObamaCare in the states. Just as the states have clearly rejected ObamaCare’s exchanges, states should equally clearly reject this administration’s relentless Medicaid expansion.
This Medicaid expansion, like the others, loses sight of the fundamentals.
Medicaid needs reform, not expansion. This federal-state health-care program provides care to over 60 million Americans and consumes a growing portion of state and federal budgets. Research shows a history of Medicaid enrollees having worse access and outcomes than private insurees. Due partly to low reimbursement, one in three doctors refuses to accept new Medicaid patients. Despite access issues, Medicaid spending continues to grow.
Instead of reforming Medicaid, the Patient Protection and Affordable Care Act expands eligibility to all individuals earning less than 138 percent of the federal poverty level. The Medicaid program already is struggling to provide care to its core obligations. Adding more people further exacerbates underlying problems.
The expansion of Medicaid fuels a larger trend under ObamaCare: government coverage supplanting private coverage. By 2021, 46 percent of all Americans will depend on the government for health care. Of this group, 86.9 million will be on Medicaid/Children’s Health Insurance Program, followed by 64.3 million on Medicare and 23.4 million enrolled in government exchanges. This will push U.S. health care closer to a government model.
There are far better ways to expand coverage and care for low-income people. It’s time to get back to the basics.
Congress should embark on a reform agenda that is grounded in the following cornerstones: (1) reforming the tax treatment of health insurance so that individuals choose the health care coverage that best fits their needs (not the government’s dictates); (2) restoring commonsense regulation of health insurance by devolving it back to the states; and modernizing (3) Medicare and (4) Medicaid by adopting policies that harness the powerful free-market forces of choice and competition.

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