Opinion: No evidence that expanding Medicaid actually helped

In December, the Legislative Finance Committee released a report on New Mexico’s Medicaid program. By design or coincidence, the report happened to coincide with the 10th anniversary of Medicaid expansion in New Mexico. Then-Gov. Susana Martinez decided to embrace the ObamaCare expansion dollars, which were 100% federally funded at the time.

The LFC report is packed with great information, but it doesn’t attempt to judge whether expanding Medicaid has been worthwhile. Unfortunately, when it comes to government programs (especially here in New Mexico), increased spending and good intentions are not often followed by a careful evaluation of whether spending has met stated goals. Analysis of whether the new program itself was cost-effective in achieving these goals is even less common.

The media covered the LFC’s report, which focused primarily on difficulties the committee’s “secret shoppers” were having in scheduling appointments with physicians for Medicaid patients. For example, the LFC found that only 15% were able to make an appointment with a GP.

Other doctors did not accept patients, did not answer calls, or could no longer be reached on this telephone number.

These results highlight an important problem with Medicaid: being “insured” (particularly through a government welfare program) does not mean you have access to medical care.

Less prominent in the news reports was the fact that the LFC reported that a staggering 47% of all New Mexicans participate in the program and that a staggering 77% of births receive Medicaid.

The lack of medical providers in New Mexico has been widely reported. While there are many reasons for this shortage, our state’s massive Medicaid population and the program’s low reimbursement rates for providers are certainly factors. Each physician will offer their views on the challenges of caring for large numbers of Medicaid patients.

The extraordinarily high number of Medicaid recipients in New Mexico is at least partly responsible for the state’s low participation rate. The LFC itself has noted that Medicaid and other state welfare programs “can act as a disincentive to work, either by excessive benefits or by cutting benefits when recipients’ wages rise.”

In addition, the LFC report notes that Medicaid is the largest health care payer in New Mexico and the state has the largest Medicaid program per capita in the country.

HSD expects total Medicaid spending to increase approximately 56 percent between FY19 and FY23, from $5.6 billion to $8.8 billion. In other words, by next fiscal year, Medicaid alone will be spending more than New Mexico’s current general fund budget.

Unfortunately, the LFC did not include a detailed discussion of health care outcomes and the impact (or lack thereof) of the Medicaid expansion. The LFC noted that “the state as a whole continues to face poor health outcomes.” More interestingly, while providing routine medical care to the poor was a stated goal of the expansion’s advocates, the LFC notes that “emergency room visits for nonurgent reasons have increased, potentially leading to poorer outcomes.”

After a decade of massive state and federal Medicaid spending increases, the LFC fails to indicate significant health care outcomes from Medicaid expansion for the New Mexico population as a whole. Given the incredible impact this program is having on state and federal budgets, it would be nice to know whether or not expanding Medicaid is having a positive impact. The LFC didn’t even mention the lack of evidence of health outcomes, much less call for such research or censured the Legislature for failing to conduct it already.

The largest and most expensive expansion of America’s welfare state in the past 50 years seems to have led to more government and more government dependency. However, here in New Mexico, with the highest percentage of people receiving Medicaid, evidence of improved health outcomes remains elusive.

Paul Gessing is President of the Rio Grande Foundation in New Mexico, which promotes limited government, economic freedom, and individual responsibility. Contact him at:

[email protected]

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