One of the big ways that Obamacare extends health care coverage is via a massive expansion of Medicaid, which pays for treatment of lower-income Americans. Never known for its swift and effective coverage, the president's health care reform gave extra money to doctors willing to provide primary care to Medicaid recipients. That ends on Thursday and "threatens access to care," according to The New York Times:
The Affordable Care Act provided a big increase in Medicaid payments for primary care in 2013 and 2014. But the increase expires on Thursday — just weeks after the Obama administration told the Supreme Court that doctors and other providers had no legal right to challenge the adequacy of payments they received from Medicaid.
The impact will vary by state, but a study by the Urban Institute, a nonpartisan research organization, estimates that doctors who have been receiving the enhanced payments will see their fees for primary care cut by 43 percent, on average….
The White House says Medicaid is contributing to the "largest coverage gains in four decades," with 9.7 million people added to the Medicaid rolls since October 2013, bringing the total to 68.5 million. More than one-fifth of Americans are now covered by Medicaid.
But federal officials have not set forth a strategy to expand access to care with enrollment, and in many states Medicaid payment rates for primary care services, like routine office visits and the management of chronic illnesses, will plunge back to 2012 levels, widely seen as inadequate….Almost 40 percent of Ohio doctors indicated that they planned to accept fewer Medicaid patients when the extra payments lapsed.
This sets up a political battle to keep the higher level of benefits and it's one that I bet goes in favor of the White House and, ultimately, the doctors who see Medicaid patients. It will be seen as too cruel to yank benefits that were misbegotten in the first place, and don't you know that more money solves all problems?
The selling point of the Medicaid expansion was that the federal government would pick up virtually all of the costs of the expansion through 2019 and then 90 percent after that. It was "free money" that only poor-hating plutocrats could pass up on. Yeah, well, regular Medicaid spending is split between the feds and the states and is already the single-largest budget item in state budgets. One way or another, it's about to become bigger still, because either the feds will squeeze more money out of taxpayers to keep the program going or will off-load more of the costs onto states. After all, it's not as if the feds could promise that the original terms of the deal would last forever. Or even the rest of this week.
A better debate to be having is whether Medicaid contributes to good health outcomes in the first place. For all the money that has been spent on Medicaid since its creation in the late 1960s, a clear positive answer to that question remains elusive. In fact, on a variety of outcomes, it's unambiguous that "health outcomes for patients covered by Medicaid…are actually worse than those covered by no insurance at all."
In 2013, Reason TV caught up with Alieta Eck, M.D. and talked with her about "How Medicaid & Obamacare Hurt the Poor—And How to Fix Them":