As Devon M. Herrick concludes his policy brief :
On paper, Medicaid coverage appears far better than what most Americans enjoy — with lower cost-sharing and unlimited benefits. But by almost all measures, Medicaid enrollees fare worse than similar patients with private insurance and often experience worse health issues than patients with no insurance. Wisconsin made a wise choice when it decided to forgo a full Medicaid expansion in favor of a smaller program that would maximize the availability of private coverage for Wisconsin’s low-income residents
Read more: Medicaid Expansion: Wisconsin Got It Right | NCPA.
More on the Medicaid ghetto here and here.
“Obamacare Enrollment is Mostly Medicaid Expansion,” writes John R. Graham. This is bad news, considering the poor quality of medical care available to Medicaid enrollees and the rampant fraud.
The Medicaid Mess: How Obamacare Makes It Worse, by Avik Roy, Senior Fellow, Manhattan Institute
What Medicaid Fraud Looks Like: Mansions, Sports Cars, Klingon Battle Swords, and 30,000 Dubious Claims, by Peter Suderman, Reason.
At Forbes, Scott Gottlieb, MD provides a warning for Coloradans who will to buy health coverage through the Colorado Health Benefits Exchange (“Connect for Care Colorado”):
There’s an astute article in today’s edition of the Wall Street Journal by veteran healthcare reporter Anna Mathews. It outlines the scope of health plans that will be offered on the new exchanges taking shape this fall. And why Obamacare is looking more and more like Medicaid.
Mathews notes that hospitals are giving up discounts to the new exchange-based health plans. In turn, the hospitals plan to make up these discounts through the narrow networks of providers that consumers will be able to choose from. The bet that these hospitals are making is that they can offset the discounts by getting more volume. …
[Wi]th fewer out-of-pocket costs, consumers will also have far less skin in the game. In turn, they will have less incentive to constrain their demand for services.
That constraint will instead be applied by the providers themselves, through the limitations that they place on access. Not by outright denying care, but by funneling patients into overworked networks that make it much harder to actually get appointments and schedule needed services. This is exactly how rising demand is managed under Medicaid. It’s one more reason why Obamacare coverage is likely to resemble Medicaid over time.
More: The New Obamacare Insurance Is Looking More Like Medicaid – Forbes.
See also: Survey: Medicaid-Level Rates Could Cripple Health Insurance Exchanges.
Linda Gorman of the Independence Institute writes:
Medicaid expansion would limit access to care for the significant fraction of the currently uninsured who would otherwise be eligible for federal premium subsidies under ObamaCare. It raises costs for state taxpayers, increases costs for people who are hospitalized, and prevents state insurers from collecting millions of dollars in federal subsidy money.
Read more: How Colorado’s Medicaid expansion harms patients | Complete Colorado – Page Two.
Avik Roy & Grace-Marie Turner in National Review present 12 reasons Virginia, or any state (like Colorado), should not expand Medicaid:
- Virginia’s Medicaid spending will explode
- Medicaid harms the poor.
- Medicaid’s access problems will get worse as more doctors drop out.
- Claims about job creation are exaggerated.
- Claims about coverage expansion are exaggerated.
- Medicaid raises premiums for those with private insurance.
- Medicaid’s undercompensated care is a bigger problem than providing uncompensated care for the uninsured.
- Expanding Medicaid will expose [states] to immense amounts of fraud and waste.
- [States] will be exposed to higher Medicaid costs when Washington recalculates its matching payments.
- By rejecting the Medicaid expansion, Virginia encourages other states to do the same, reducing waste of taxpayer dollars.
- Medicaid will worsen the cycle of dependence and harm the economy.
- Exchanges will provide better health outcomes, far less fraud, and fiscal certainty.
Read details on each: Twelve Reasons to Say No – National Review Online.
For more on Medicaid expansion, see posts on Colorado Medicaid.
On December 30, Michael Booth of the Denver Post writes:
Free money now, untold costs later.
That’s the dilemma facing Gov. John Hickenlooper, state officials and legislators in 2013 as they contemplate one of the biggest questions in Colorado’s health future: Should we jump into the historic expansion of Medicaid that is a key element of health-care reform?
Read more: Will Colorado go all-out to broaden Medicaid pool?
Health economist John C. Goodman summarizes the poor medical outcomes on people enrolled in Medicaid, compared to those with commercial insurance or the uninsured. He notes:
[Austin] Frakt points to some studies finding that Medicaid makes a positive difference over being uninsured. But the results would probably have been just as good or better if we spent the money giving free care to vulnerable populations. Moreover, even with their Medicaid cards, enrollees turn to emergency rooms for their care twice as often as the privately insured and the uninsured.
Read Goodman’s whole post: How Bad Is Care under Medicaid?
John C. Goodman writes:
It’s painful to read Paul Krugman when he writes about health care. Makes you wonder how he ever won the Nobel Prize. Previously, he made the absurd claim that in repealing health reform Mitt Romney would allow “tens of thousands” of people to die. In his latest venture into the field, about which he knows embarrassingly little, he has this to say …
Read more: Krugman Flunks Health Econ 101 | John Goodman’s Health Policy Blog | NCPA.org.