Why not let people above the Medicaid income threshold buy Medicaid?

[Lee-Lee]

10. Looks like in NC the average spending per Medicare patient is just over $10,000 per year

If we assume that your typical person buying in optionally will have the same burden to the system then they will need to pay a premium of that much to have the idea break even.

And on top of that they will need their supplemental plans to go with it.

So your looking at a person paying around $12,000 a year in premiums for the math to work out extending Medicaid optionally and covering the cost with premiums. Now it could be argued that it would be younger people with fewer expenses buying in than your average recipient now, but it could also be that the people with the most difficult cases who can't find coverage anywhere else will be the ones buying in and things would be more expensive. You won't know until it's down.

That's why an optional buy-in won't work. It would require either crazy high premiums or increased taxes to pay for subsidies for those buying in, and people are too greedy to go for subsidies for other people. You have to force everyone in at once or by groups by gradually lowering the age to make it the same across the board for it to be politically viable here.