Obamacare = Medicaid


I have been interested in health care reform for some time and have proposed a plan for reform. It is now too late for such a reform as Obamacare has engaged the political apparatus and sides have been taken. The Obamacare rollout was worse than anticipated and it was hoped that the Supreme Court would have mercy on the country, but that didn’t happen and it has been the law for two years.

What has it accomplished ? Well, the forecast drop in ER visits hasn’t happened. It also didn’t happen in Massachusetts when that plan took effect.

Wasn’t Obamacare supposed to solve the problem of people going to the ER for routine medical problems? We were told that if everyone had “healthcare” — either through the ACA exchanges or through Medicaid expansion — people would be able to go to their family doctors for routine care and emergency rooms would no longer be overrun by individuals who aren’t actually experiencing emergencies.

As it turns out, Medicaid patients can’t get appointments with physicians.

“America has severe primary care physician shortages, and many physicians will not accept Medicaid patients because Medicaid pays so inadequately,” said Michael Gerardi, MD, FAAP, FACEP, president of the ACEP.

The report — commissioned by the Emergency Medicine Action Fund — found that the median wait time to see a physician in the Medicaid managed care plan is two weeks but over one-quarter of the providers had a wait time of more than a month for an appointment.

When I was in practice, Medicaid (Known in California as MediCal) was notorious for paying poorly and very late. It took two years to get a payment of about 20% of the billed charge. What about now ?

Medicaid expansion—one of the keystones of ObamaCare—is anything but “a good thing” for the patients already relying on the Medicaid safety net. These truly vulnerable patients face second-class care as a new Medicaid expansion population is rushed to the front of the line. But what does this expansion population really look like? And what will be the impact of ObamaCare’s expansion on the needy patients who count on Medicaid to survive?

Able-bodied, working-age adults; almost all of whom (82 percent) have no children to support, nearly half of whom (45 percent) do not work, many of whom (35 percent) with a record of run-ins with the criminal justice system. ObamaCare has picked this population as the winner of its Medicaid expansion.

The population with employer-provided private insurance has been left alone until Obama leaves office.

The Patient Protection and Affordable Care Act (PPACA) employer “shared responsibility” mandate, originally set to take effect in January 2014 but delayed last year until 2015, will now be phased in so that midsize employers will not be subject to “play-or-pay” penalties until 2016, the Treasury Department announced on Feb. 10, 2014. The department issued a new final rule and related questions and answers on Employer Shared Responsibility Under the Affordable Care Act.
Treasury defines midsize organizations as those with the equivalent of 50 to 99 full-time employees, and, according to the agency, they represent about 2 percent of U.S. employers. Businesses with fewer than 50 full-time equivalent workers, which make up about 96 percent of all employers, are not subject to the play-or-pay provisions.

Interestingly enough, this has led to a new scandal involving Republicans.

Congress’s fraudulent application to the District of Columbia’s health exchange — the document that facilitated Congress’s “exemption” from Obamacare by allowing lawmakers and staffers to keep their employer subsidies. The application said Congress employed just 45 people. Names were faked; one employee was listed as “First Last,” another simply as “Congress.” To Small Business Committee chairman David Vitter, who has fought for years against the Obamacare exemption, it was clear that someone in Congress had falsified the document in order to make lawmakers and their staff eligible for taxpayer subsidies provided under the exchange for small-business employees.

Another example of why we have the worst ruling class in our history.

Now, the level of corruption has reached new heights and we are not even allowed to have Inspectors General, the traditional agency that kept the bureaucrats honest.

Then again, nondisclosure seems to be a habit with this IG office—ranging across years and different officials. USA Today reported in March that the office has conducted 140 health investigations since 2006 that had never been made public. Under growing pressure, the IG finally released them late last week, and the newspaper ran a follow-up noting that the cases ranged from “missed diagnoses” to “failures during surgery” to “misuse of funds” to “personnel issues” to yet more facilities that may be giving “questionable amounts or combinations of narcotics.” In many cases, said the newspaper, “the department’s chief watchdog trusted the VA to correct problems on its own.” Really?

That’s from one IG office. What about others ? Many don’t exist.

The episode is also raising questions about whether President Obama perhaps likes it this way. Mr. Griffin has been the supposedly temporary acting IG at Veterans for more than two years, an uncertainty that may in itself be feeding into office problems. He’s still there because Mr. Obama has failed to appoint a permanent head. In March, all 16 members of Mr. Johnson’s committee—Republicans and Democrats—wrote to Mr. Obama noting that there were 10 IG vacancies, including for such not-so-minor posts as Interior, the CIA and Export-Import Bank. They noted that there were nominations pending for only two of the 10, and requested he move quickly to fill the rest.

The ruling class does not appreciate attempts to inquire into its actions.

In the meantime, Medicaid patients wait.

7 thoughts on “Obamacare = Medicaid”

  1. This is socialized medicine. It’s just like socialized education: fully politicized, expensive and low quality. The bureaucrats then lie about their performance, lose or hide the damning reports, and fire any IG who gets too inquisitive. Voters reliably return to the polls and vote for more of the same. Rinse and repeat.

    It’s almost funny. Monty Python is a closer rendition of reality than most news programs.

  2. “The application said Congress employed just 45 people”

    I’d say “Shame on them,” but we’re way past that. Eventually someone will be hanged for this sort of thing.

  3. Try writing to your Senators or Congressmen about the problems that keep cropping up. They will tell you that Medicaid is a local and State problem and that they have no jurisdiction over such matters. Did they really think they could avoid complaints about their wonderful creation?

  4. Voters reliably return to the polls and vote for more of the same. Rinse and repeat.

    I must disagree.

    No one intentionally votes for disaster.

    Thing is, most voters aren’t interested in politics, don’t follow it, and generally despise politicians. But when they vote, if they bother, they have to pick someone for any given office. Those someones, of course, work really hard to win votes, which very often requires them to conceal their true aims or opinions.

    End result, the voters get mad, vote for the other party the next time, or think less of the one they still vote for. But they get madder and madder, each time they vote and get betrayed, and they trust the political class less and less every year.

    I think the real opinion of the public about the present regime is similar to the result the huge tax increase embodied in Michigan’s Proposal #1, just last Tuesday. That proposal, by the way, had the endorsement of just about every bit of Michigan’s political establishment, including the Republican governor, all members of the legislature from both parties except for a handful, the mainstream media, unions, with millions spent in favor and not much in opposition.

    It lost by a record margin, about 80-20 against.

    I suppose it could just be a fluke, but I think if the voters trusted the political class that proposal would have at least managed to lose gracefully.

    But no one else was on the statewide ballot, and no one was forced to pick the lesser of two evils.

    I don’t know how this situation will end but I think it will end, one way or another.

  5. More evidence of the failure of Obamacare to accomplish any of its goals.

    Mr. Archambault reveals years of third-rate technological work, disregarded deadlines, pervasive mismanagement, little outcome measurement and general bureaucratic incompetence. An outside auditor noted as early as 2012 that the “quantity and/or skills/experience level of project resources may be impacting the ability to complete project tasks within planned timeframes” and questioned if staff were “sufficiently knowledgable.”

    A test before going public showed a 90% failure rate, and the new connector detonated on the launch pad. Some 320,000 residents attempting to gain coverage had to be dumped into a temporary “free” Medicaid program without any income eligibility determination. Pioneer pegs the total cost of the mess at around $1 billion.

    This is Massachusetts, which was the “Beta” version of Obamacare, and it is as bad as Oregon.

  6. Your medical system exists for profit. This is your problem, and the solution is well demonstrated across the civilized world.

    Go ahead with what you are doing, not only is it great theater, but it will make a fine example of what not to do.

  7. F**D, PenGun. The US leads the world in medical innovation, including advances that may well save your sorry, undeserving *ss. And it’s not just US companies either–European drug manufacturers such as Novartis do a very large portion of their development and testing here because the environment for such things is better in the US than anywhere else.

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