It is dangerous to the poor. Congress cannot keep borrowing money forever. The Congressional Budget Office projects that by the end of 2020, the federal debt will exceed the size of the U.S. economy. When, inevitably, Congress hits a borrowing constraint, it will cut spending. First on the chopping block will be the Medicaid expansion, because it was never popular in the first place. Expanding Medicaid means putting millions of necks on that chopping block.
The ACA’s Medicaid expansion favors the able‐bodied over the truly needy. The Medicaid expansion encourages states to provide better care for able‐bodied childless adults and to cut services for expectant mothers, children and the elderly.
Expanding Medicaid would discourage the pursuit of better, lower‐cost ways of delivering care to its target populations. Coverage does not equal access. Nor does it equal quality. Government‐provided coverage locks in existing delivery systems and stifles innovation. It took an international crisis for providers to discover the benefits of telemedicine, largely because Medicare and Medicaid do not innovate.