By Kyle Wingfield
[A version of this commentary was published in The Athens Banner-Herald on April 21, 2020.]
Right on cue, proponents of Medicaid expansion are touting the program as a way for Georgia to fight the COVID-19 pandemic. When all you have in the way of solutions is more government spending, then every crisis, challenge or blip on the radar looks like a reason for more government spending.
A brief primer: Expanding the program intended for the truly vulnerable would add about half a million able-bodied Georgia adults to its rolls at a cost of more than $3 billion per year. (Both numbers figure to be higher with thousands of Georgians losing their jobs.) The state would be on the hook for 10% of that.
There was uncertainty about where those hundreds of millions of state tax dollars would come from even when times were good; it’s a mystery how they’d materialize now that the state is likely to experience a recessionary budget shortfall that reaches into the billions.
If the argument is Georgia would be better positioned to fight the coronavirus if the state had expanded Medicaid, we should examine what evidence we have at this juncture. How better to do that than to look at what’s happening in the states that did expand Medicaid?
The expansion argument is also playing out in Kansas, where the Kansas Policy Institute compiled the COVID-19 infection rate and death rate per million residents for all 50 states plus the District of Columbia as of April 15, then sorted them into expansion states and non-expansion states. Those data inform the following observations.
In the 36 states plus D.C. that expanded Medicaid, for every 1 million people there have been 2,526 infected persons, and 119 deaths attributed to the virus.
In the 14 non-expansion states, the infection rate is 809 – less than one-third the expansion-state rate. The death rate is 24, which is barely more than one-fifth the expansion-state rate.
As you would expect, non-expansion states have higher uninsured rates: Of the 10 worst states on that score, according to the Kaiser Family Foundation, only Alaska and Idaho expanded Medicaid. (Georgia is tied for the third-highest uninsured rate.)
Yet, on average the higher-uninsured states’ infection rate was about one-quarter of the rate in the 10 states with the lowest uninsured rates; their death rate was about one-fifth as high. Even excluding New York – which leads all other states by a wide margin – the higher-uninsured states have less than half the infection and death rates of the lower-uninsured states.
Only three states were still projected as of April 22 to experience a hospital-bed shortage, according to the oft-cited model by the University of Washington’s Institute for Health Metrics and Evaluation. All are expansion states in the Northeast. Eight additional states, plus D.C., were projected to have too few ICU beds at some point; all but Wyoming have already expanded Medicaid. Georgia didn’t need to expand Medicaid to stay off those lists.
Could it be that the rates are higher in some states because they expanded Medicaid? This is not to suggest care in those states is worse – although, as the Foundation has pointed out in the past, Medicaid patients have a hard time finding doctors who will see them. Expansion supporters, however, can be expected to argue that people in non-expansion states are suffering silently because they can’t go to the doctor, and thus can’t get tested.
That is unlikely, not least because emergency rooms are, as ever, required to take patients even if they are uninsured. Furthermore, the reason some states are thought to have undercounted COVID-19 patients is because of a lack of available testing kits and facilities. Medicaid expansion has no bearing on the supply of tests.
If Medicaid expansion is helping states stave off COVID-19, the evidence not shown up . Nor is it likely to.
[Kyle Wingfield is president and CEO of the Georgia Public Policy Foundation, a trusted, independent resource for voters and elected officials. Established in 1991, the Foundation provides actionable solutions to real-life problems by bringing people together.]