Forbes Magazine noted that one of the major provisions of Obamacare was to adjust the Medicaid eligibility threshold, having the effect of adding millions of low income Americans to its rolls.
One of its consequences will be to aggravate the doctor shortage plaguing that program. The New York Times writes, “Medicaid for years has struggled with a shortage of doctors willing to accept its low reimbursement rates and red tape, forcing many patients to wait for care …”
Yet in just five weeks, millions of additional Americans will be covered by the program, many of them older people with an array of health problems. The Congressional Budget Office predicts that nine million people will gain coverage through Medicaid next year alone. In many of the 26 states expanding the program, the newly eligible have been flocking to sign up.
It will also replace previous complexities in the system with new ones of their own devising. The Supreme Court “ ruled that a state may “opt out” of the expansion without jeopardizing its existing federal Medicaid contributions. Many states did exactly that while others are allowing the expansion. One source reported that, as of October 22, 2013, 15 states have opted out, 7 are leaning that way, 21 are participating, 3 are leaning in that direction, and the rest are considering an alternative model.”
Despite Obamacare, the health care system cannot be made to work without actions taken at the state level. Ironically, Obamacare advocates are now arguing that it is the states which can make Obamacare work. But they can also break Obamacare by generating liabilities that the Federal Government must meet. Many of the states identified as success stories have achieved ‘success’ by revving up enrolment in an established program -- Medicaid.
A lot of the early enrollments have been in Medicaid, not private health insurance. In Washington state, for example, 98,000 people had enrolled through its Obamacare exchange as of Nov. 14 — but only about 12,000 of those picked private health insurance plans. The rest will be in Medicaid, including 47,000 people who will get the expanded coverage next year and 40,000 who qualify under the old, pre-Affordable Care Act rules.
The NY Post reports “ObamaCare is going to push 300,000 additional New Yorkers onto the Medicaid rolls by next year — a hefty 7.3 percent increase, Gov. Cuomo’s budget office predicts.” What Governor Cuomo cannot predict is how these Medicaid bills can be met or whether there will be doctors to attend the patients. Obamacare will in effect create a vast system of income and resource transfers between the states because of the varying degrees to which they are exposed to indigent treatment. States must either regain autonomy over their health care environments or risk losing budgetary autonomy altogether.