More evidence that Obamacare is just expanded Medicaid.

I have been saying that Obama care is just Medicaid for all. As time goes by, here is more and more evidence that this is the case.

The latest evidence is in The Wall Street Journal and behind a pay wall but I will quote some of it.

But a new paper from the Heritage Foundation, however, suggests that nearly all of the increase came from adding nearly nine million people to the Medicaid rolls.

In other words, ObamaCare expanded coverage in 2014 to the extent that it gave people free or nearly free insurance. That goal could have been accomplished without the Affordable Care Act. To justify its existence, ObamaCare must make affordable private insurance available to a broad cross-section of uninsured Americans who are ineligible for Medicaid.

But with fewer people buying insurance through the exchanges, the economics aren’t holding up. Ten of the 23 innovative health-insurance plans known as co-ops—established with $2.4 billion in ObamaCare loans—will be out of business by the end of 2015 because of weak balance sheets.

And while rates vary widely by state, the cost for private insurance through the exchanges is also increasing dramatically. An analysis by consulting firm Avalere Health released on Friday shows that some of the most popular insurance plans in the ObamaCare exchanges will experience double-digit premium hikes in 2016.

My earlier objections to Obamacare were that it promises too much and pays too little.

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?

The Heritage study will be discounted by the left. Still it does examine the results of Obamacare at year three.

Last year’s changes in health insurance enrollment are of particular interest, as 2014 was the year in which key provisions of the Affordable Care Act (ACA, or Obamacare) took effect—most notably, the offering of subsidies for coverage purchased through the new government exchanges and the ACA’s Medicaid expansion. Analysis of enrollment data for private health insurance plans and public programs finds that 9.25 million more Americans had health insurance coverage at the end of 2014 than at the end of 2013.[1] However, the data (see Figure 1) also show that the ACA’s Medicaid expansion was responsible for almost all of the net increase in coverage.

What happened to the Employer Mandate ?

For the employer-group-coverage market, enrollment in fully insured plans dropped by 6.6 million individuals, while enrollment in self-insured plans increased by 2.1 million individuals.[2] The net effect of those changes was a decrease of 4.5 million in the number of individuals with employer-sponsored coverage in 2014.
Because the reduction in employer-group coverage offset almost all of the increase in individual-market coverage, the net change in private-market coverage during 2014 was an increase of just 260,000 individuals.

The Employer Mandate was supposed to take effect in 2014. That, however, was an election year and Democrats have been battered by the fallout from Obama’s “Signature Achievement.”

Medicaid enrollment growth during 2014 occurred disproportionately in states that adopted the ACA Medicaid expansion. In the states with the Medicaid expansion in effect, enrollment grew by 23.2 percent; while in the states without the expansion in effect, enrollment increased by 2.9 percent—or just above the pre-ACA trend.

Governor Kasich was one of the few GOP governors who adopted this Medicaid expansion. Perhaps he should be asked about it.

Conclusion ?

The implementation of the ACA appears to have had three effects on insurance coverage in 2014: (1) a modest shift among enrollees with prior individual-market coverage from “off-exchange” to “on-exchange” plans; (2) a substantial increase in individual-market enrollment that was matched by a nearly equivalent decline in employer-group plan enrollment (particularly among fully insured group plans); and (3) a significant increase in Medicaid enrollment, particularly in the states that had the ACA Medicaid expansion in effect during the year.
In sum, when it comes to increasing the number of individuals with health insurance coverage, the net effect of the ACA in 2014 was almost entirely a simple expansion of Medicaid.

This is what I predicted.

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.

Those pesky elections again.

6 thoughts on “More evidence that Obamacare is just expanded Medicaid.”

  1. Except it’s also Fannie Mae and Freddie Mac all over again as well. First impact of Obamacare was in 2009 in the stock market with correctly anticipated crony profits, but it completes the circle with the middle class equity wipeout in progress for any of the saps who aren’t bottom tier who signed the fine print [$1 million out of pocket, see Mercer policies].

    There is nothing so irrational as the commons chasing “entitlements.” No investor or madness of crowds compares.

    But yes finishing the co-opting of medicaid into the warm snug fold of cronyism is part of it…and guess who else is being “reinvented”?

    The VA. That’s what all the bad PR was about. The VA’s shortcomings have been a constant for decades. The eye of Sauron never focuses for long without profit$.

  2. Proof is that Obamacare was not intended to “insure” the uninsured, but to expand government control of medicine for others. The key is that right now, health care payments by entitlement agencies (Medicare, Medicaid, VA, Tricare) cannot be tolerated without bankrupting the country. This would starve all other progressive causes. If you cannot do a UK Style National Health, you cannot adequately ration care. The progressives take the long view and this is the key.

  3. “If you cannot do a UK Style National Health, you cannot adequately ration care.”

    Yes, but the doctors leave.

    And treatment is worse in the NHS. Worse than the rest of Europe and worse than the US.

    Researchers say the main reason for low survival rates in the UK seems to be delayed diagnosis, underuse of successful treatments and unequal access to treatment, particularly among elderly people.

    Then the Brits themselves compare.

    the age-standardised figures are 24 deaths per 100,000 Britons, and 19 per 100,000 Americans – not nearly so dramatic a difference.

    ‘Fewer prostate cancer patients survive five years’

    Another fact that has been widely quoted relates to prostate cancer. As the Guardian wrote:

    A Lancet Oncology global study last year found that 91.9 per cent of Americans with the disease were still alive after five years compared to just 51.1 per cent in the UK.

    One interesting point.

    As we’ve written before, the US uses the PSA blood test far more widely than we do in the UK – despite questions over how effective it is at spotting cancers that would actually kill, as opposed to those that cause no symptoms.

    As a result, the USA has one of the highest recorded rates of prostate cancer in the world.

    So although it’s undoubtedly ‘better’ at spotting prostate cancers, it’s also fair to say that some of these Americans will never die from their disease.

    This ‘overdiagnosis’ inflates the survival statistics, at the expense of ‘overtreating’ men – which is expensive and can cause long-term side effects (which can need further treatment).

    So you might just as well argue that the ‘91 per cent’ survival figure could be due to a system that overdiagnoses and overtreats prostate cancer, as opposed to saying our 51 per cent stat is due to poor healthcare in the UK. Bigger is not always better.

    Yes but maybe it is.

  4. Obamacare Fine Print: Beware the Medicaid and Medi-Cal Clawbacks and Liens

    === ===
    [edited] Medi-Cal, and many other state Medicaid programs include a ‘claw-back’ provision for recovery of costs incurred by the state to provide medical care. With some variation among states, these costs include a monthly ‘administrative fee’

    The ‘claw-back’ mechanism allows the state to place liens on individual assets when the Medicaid recipient reaches age 55, then recovers the money when he dies by seizing the money from the estate.

    Medi-Cal estate recovery reclaims certain Medi-Cal costs from the estates of beneficiaries after their death. This program has received renewed attention from policymakers because of reports that some individuals newly eligible for Medi-Cal under the Affordable Care Act may not enroll for fear that their house and assets could later be seized.
    === ===

    Medicaid was used mostly by people who had little assets. Now, the ACA is sweeping up many people at the margin who have significant assets (example: a house) but little enough income to need the ACA to meet the increasing insurance payments. Most of these poeple don’t know about the clawback.

    The ACA guides people into medicaid without telling them that it may amount to a loan for medical care. That is not insurance, which is a way of defending assets against unusual and expensive medical conditions.

  5. Good point, Andrew. Early in the story there were a number of accounts of people applying for “insurance” through the exchanges who ended up with Medicaid as their only choice,

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