Forget ObamaCare; It's Plain Old Medicaid
By DICK MORRIS
Published on
DickMorris.com on October 28, 2013
Enrollment figures from state ObamaCare exchanges are revealing a
pattern that will alter fundamentally the terms of the debate over
Obama's signature health insurance program.
When it was proposed, considered, and enacted, it was seen as a program
requiring everybody to buy private insurance on health exchanges or face
a fine. Those already covered with "affordable" and sufficiently
comprehensive health care policies were exempt from the mandate.
And, oh yes, for the poor, the bill expanded the Medicaid program
substantially.
But now experience with ObamaCare sign-ups at local exchanges indicates
that it is the Medicaid feature of the program that is attracting the
most attention and enrollments.
In Washington State, for example, 88% of the enrollments have been in
Medicaid. In Kentucky, 82% were on Medicaid. In New York
State, two-thirds of the new enrollments were into the Medicaid program.
Should this trend continue in other states and in federal exchanges
-- and there is no reason to assume they won't -- ObamaCare will amount
to little more than an expansion of Medicaid.
The debate over single payer v private insurance will have been resolved
by the lack of interest among the near-poor in the private program and
their inability to afford even subsidized premium levels.
ObamaCare will have been a massive expansion of single payer,
state-provided coverage and little else.
One can imagine the day when Obama announces proudly that he has
extended health coverage to, say, seven million Americans. But an
examination of the fine print will reveal that six million will have
come through Medicaid. Good, old fashioned Medicaid, a program
that has been kicking around for 50 years.
Nationally, 82 million Americans are one Medicaid, making it the largest
of our entitlement programs. Only 46 million, by comparison, get
Medicare. 47 million get food stamps. 50 million get Social
Security. But Medicaid is, by far, the largest program.
By the time it is expanded, as provided in ObamaCare, it will surge to
over 100 million in its coverage.
This change in enrollment patterns raises some key questions:
1. Do we need ObamaCare? The massive
edifice of exchanges, subsidies, regulations, coverage requirements
enacted with ObamaCare are scarcely necessary if they cover only a few
million people.
2. What of the implications for state budgets?
If ObamaCare is to be largely a Medicaid expansion, what will the impact
on state budgets be? Those who enroll under the newly expanded
Medicaid eligibility standards will be financed fully by the feds for
three years, after which the states will be obliged to chip in 10% for
another three years. After that, the funding goes back to the
usual federal-state Medicaid match of 1/3 to 1/2 federal funding.
Since many states have opted not to expand their Medicaid coverage, this
effect will not be universal, but it will be significant.
But the experience of the state exchanges indicates that about a third
of the new enrollments are by people who have been eligible all along
for Medicaid and just didn't sign up. Caught up in the hoopla
about universal coverage, they are now seeking to enroll in Medicaid.
But the states will not get special reimbursement for these new
enrollees. The normal Medicaid match of 66-33 or 50-50 will apply,
breaking the bank for many states.
So, as it turns out, ObamaCare will be financed in large part by state
taxpayers: an outcome nobody had foreseen.
Copyright © 2013 DickMorris.com
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