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. 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. 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.
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.