Medicaid

Medicaid's Miserable Health Access

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Roughly half of ObamaCare's coverage expansion comes via an expansion of Medicaid, the joint federal-state health program for the poor and disabled. Thanks to ObamaCare's giant-sized expansion of the program, it's set to become the single largest insurer in the nation, with about 76 million enrollees by 2021.

But Medicaid's patient access is remarkably poor. Children, in particular, have trouble finding doctors who will see them. According to a new report by the Government Accountability Office, at least 75 percent of physicians are enrolled in Medicaid and its sister program, the Children's Health Insurance Program (CHIP). Yet that doesn't guarantee access to care, especially in comparison to private insurance: While 79 percent of providers are currently taking privately insured kids as new patients, only 47 percent are taking new patients from children enrolled in Medicaid. 

Specialty care is even harder to come by, according to the GAO:

More than three times as many participating physicians—84 percent—experience difficulty referring Medicaid and CHIP children to specialty care as experience difficulty referring privately insured children—26 percent. For all children, physicians most frequently cited difficulty with specialty referrals for mental health, dermatology, and neurology.

Surely newly enrolled kids are still better off in Medicaid versus the alternative? Not necessarily. That's because millions of kids who end up on Medicaid or CHIP would have otherwise been insured privately. In 2008, the Congressional Budget Office estimated that about a third of the 5.8 million kids covered under a CHIP reauthorization would have been covered privately. In general, CBO estimates that "for every 100 children who gain public coverage as a result of SCHIP, there is a corresponding reduction in private coverage of between 25 and 50 children." 

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  1. (waves hand in front of Suderman’s face): These are not the statistics you’re looking for.

  2. Didn’t want those kids anyway.

  3. But Medicaid’s patient access is remarkably poor. Children, in particular, have trouble finding doctors who will see them.

    I wonder why.

    1. Because the mandated payment levels don’t cover the overhead for the service, much less contribute to paying off that $300,000 in student loans.

  4. They’ll probably just invoke the Almighty Commerce Clause and force the doctors to take them.

    1. Yes, probably. We’ve already lost the semantic battle since we all keep referring to “Obamacare”, “the health care debate”, and so on, when it’s not health care we’re debating but health insurance.

      1. It’s not even insurance anymore, it’s a subscription plan. Has been for decades.

      2. Do you have a better name?

        1. “Care” to me ( and to most normal people, I would assume) refers to the service, not the method of financing the service. People are always referring to the uninsured as lacking access to “healthcare,” for example, which is not correct. This implies that anyone without a 3rd party contracted to pay their medical bills is fully incapable of going to the doctor. And “insurance,” as stated by others above, does not even refer to “insurance,” as insurance is normally/properly defined. It’s just a subscription scheme of indirect payments. If I have a doctor, and he will give me an appointment and set a price, and I am able to meet his price, why the fuck should I need any 3rd party involved in that process? Instead of paying some company ( or having the government handle it) hundreds of dollars a month for a “plan”, why wouldnt I just pay the doctor? Health “care” plans might make a lot more sense for the actual “insurance” part- you know, those unpredictable events that would bankrupt most people. But very few people are really interested in insurance, and the millions of people with their “health care plans” are fucking up the market for people who want to have normal insurance and are probably worse than the people on welfare IMHO.

    2. Also, they’ll argue that once we force all the other insurance reimbursements down to Medicaid levels, doctors will have no choice but to accept them.

      1. I hear Western doctors can live a pretty luxurious lifestyle in Thailand.

        1. Actually, this is pretty true from what I’ve heard for ex-pats in general in Thailand. The dollar goes pretty far there, and it’s not a bad place. I know several people who’ve lived in SE Asia, and while you’d hear them complain endlessly about India, they all seemed to love Thailand.

    3. Yep, and they’ll jack up the charges to the private insurers to make up for it. And when the insurer won’t pay beyond a certain amount you will have to make up the difference.

      Soviet America hates productivity.

  5. Speaking as a consumer of Medi-Cal[*], I can attest that it sucks. The system is designed to reduce doctor visits and access to specialists.

    TRICARE was worse.

    My own personal Anthem plan, which is an eeeeevil, for-profit plan with premiums that go up every year, has been problem-free. The premiums were so low to begin with that the plan is still a bargain despite 10% or so annual increases.

    [*] Not myself.

    1. Making it even worse, these days Medi-Cal recipients have to pay for dental work and their glasses. We’re talking, quite often, about people who get less than a thousand dollars a month.

  6. Surely newly enrolled kids are still better off in Medicaid versus the alternative? Not necessarily. That’s because millions of kids who end up on Medicaid or CHIP would have otherwise been insured privately. In 2008, the Congressional Budget Office estimated that about a third of the 5.8 million kids covered under a CHIP reauthorization would have been covered privately. In general, CBO estimates that “for every 100 children who gain public coverage as a result of SCHIP, there is a corresponding reduction in private coverage of between 25 and 50 children.”

    “These crowd-out rates are probably about as low as feasible for a voluntary program, given the size of the proposed coverage expansion. (It is possible to implement policies to reduce crowd-out below that level, but those policies would most likely also reduce the number of children enrolled in the program who would otherwise be uninsured.)”

    1. Yep, Suder Man’s post makes it appear SCHIP is preventing children from being privately ensured, while the reality is that the parents/guardians of those children chose SCHIP over a private plan.

  7. I tried to popularize “Obamasurance,” but it didn’t catch on.

  8. After the recent incident people think the only place an American in USA can be guaranteed appropriate medical care (at the top of the list/front of the line) is in prison but good alernative for now is “Penny Health” check it out

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