Medical dollars
Patrick Ishmael

Supporters of Medicaid expansion have long played loose with the facts of the program, and this year is no exception. Earlier this year, my colleague Elias Tsapelas scuttled the notion that Missouri would “save money” by expanding Medicaid. Expansion backers have now pivoted to an oldie-but-goodie talking point: that Missouri would be “bringing home” their tax dollars from Washington. 

It was nonsense five years ago when they made the argument to the legislature, and it’s nonsense now. 

I won’t republish my entire Forbes piece here, so click the link above if you’re interested in the original editorial. But plainly, the expansion does not operate like the public is now being told it does in TV ads.  

  • There is no federal pot of money divvied among participants when other states don’t join the expansion. If only one state expanded Medicaid, that one state wouldn’t then receive the funding of the 49 non-participating states. It’d receive money for its program and no more. 
  • Missouri already receives more in federal support than our federal contribution warrants. We rely more on federal money than most other states, and we’re already getting more than our “fair share” in federal cash even without expansion. 
  • But perhaps most importantly, there are no “tax dollars” being “sent back” to any state, especially these days. We are in a period of extraordinary deficits, and that means every new dollar spent by the federal government is from debt, not from taxes paid.

Medicaid expansion is debt, plain and simple, and yet it will still require redirecting existing state money currently earmarked for education, public safety, infrastructure, and other priorities to feed the Medicaid program’s insatiable appetite.  

It’s Medicaid expansion debt. Supporters should be honest with the public and call it what it is. 


About the Author

Patrick Ishmael
Director of Government Accountability

Patrick Ishmael is the director of government accountability at the Show-Me Institute.