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Bankrupt Healthcare
The Grey Lady Deflates the Medicaid Expansion

Even the New York Times has started to notice that Medicaid’s access problems are about to get even worse. Robert Pear reports on the imminent expiration of the Affordable Care Act’s temporary Medicaid payment increase. Though the ACA provided federal money to reimburse for Medicaid patients at the same rate as Medicare, that provision stops on Thursday. In may states, that expiration is going to be extremely disruptive:

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.

Stephen Zuckerman, a health economist at the Urban Institute and co-author of the report, said Medicaid payments for primary care services could drop by 50 percent or more in California, Florida, New York and Pennsylvania, among other states.

What this means is that Medicaid reimbursement rates will plummet just as the program is adding many new people to its rolls—9.7 million, as a matter of fact. Doctors will close their doors to Medicaid patients in favor of people with better insurance, and the Medicaid expansion, a center-piece of the ACA, will in practice mean little to those patients who face serious access problems. With even the New York Times noting this, the Obama administration and ACA supporters should no longer be able to get away with sweeping the access question under the rug.

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  • calhou

    Given that this result was clear even before Obloatedcare was rolled out, why is anyone surprised. The whole thing is one big lie. The nation has been “Grubered.”

    • FriendlyGoat

      So, your side has the Congressional majority to fund Medicaid to a proper level to make it work for both doctors and patients. Such legislation wouldn’t even face a Senate Democratic filibuster or a presidential veto. This Gruber problem should have a very simple fix. Are your guys ready to do it? Are you asking them to?

      • Gene

        I like the way you just sliiiiiide ever so quickly past the fundamental question of whether “Medicaid for all” is actually, you know, the best way to fix health care, and suggest that the “solution” is for the Repubs to just give up and accede to whatever the Dems put in place by funding it to your heart’s desire. IOW, the debate’s over, we’ve figured out how to fix health care, just give us as much $$$ as we ask for regardless of the consequences for the economy, for the rest of the federal and state budgets, etc., and voila! Problem solved.

        The world is a simple place after all! Who knew?

        • FriendlyGoat

          Are you saying you don’t want to do anything, or just saying you want to sell (unspecified) insurance products “across state lines” (from the least-regulated GOP state with the least possible policy standards)—-the standard Republican retort?

          We do not have a shortage of money for fixing health care in this country. The Federal Reserve printed trillions of dollars of it to pump up the stock market for the half (or so) who have ownership interests in stocks. How about the other half? Can’t let any of the printed money go though them on the way to the corporations?

          • Josephbleau

            Let’s Print Enough Money to give everyone $1 MM and we can all live like movie stars! This is certainly correct per your comment!

          • FriendlyGoat

            You are at liberty to make your own goofy comments. Mine don’t justify yours.

          • Fred

            You’re right. One goofy comment doesn’t justify another.

          • Boritz

            Then wouldn’t that hypothetical “least-regulated GOP state with the least possible policy standards” benefit from being able to purchase policies from a democrat state with really specific highly regulated standards if it wasn’t forbidden? You didn’t think of that?

          • FriendlyGoat

            The idea of “across state lines” is first to repeal the federal (Obamacare) standards and THEN to sell poor policies to poor people. The idea is for insurers located in a state with nearly no standards to offer the practical equivalent of payday loans in every state. Such policies become the cheapest thing in the market—–whether they offer much protection or not—–and Republicans can say “Look, there is something in the marketplace for every budget”. Those poor policies also become the new low standards then requested by Republicans in other legislatures to be “competitive”. All this takes place while employers back slowly away from group plans, of course.

            AT PRESENT, per your example above, all of the policies are meeting Obamacare standards—-you know, the standards you want to repeal. No one needs to worry much about where they can find a good policy from a well-regulated state at this time, because we have federal standards over all of them—–until you get your way.

      • calhou

        A simple problem to fix…….if we didn’t have 18 trillion in debt.

        • FriendlyGoat

          Your side was not the least bit interested in fixing it when we didn’t have 18 trillion in debt, you know.

          • Corlyss

            Friend, you’re becoming depressingly predictable. Republicans are the only people who’ve tried to do something about the deficit. And don’t go quoting me about Saint Bill’s wonderful deficit reduction, which was attained only 1) because Hillarycare never happened and 2) the Republican Congress forced him to concede on spending.
            Do let me know when you’re ready to turn over 100% of your company’s receipts and all the change in your pocket to save the poor, to rescue the tempest-tossed refugee, to pay the medical bills of all. You can post here. I’ll probably catch it eventually.

          • FriendlyGoat

            The question, Corlyss, is what were Republicans EVER going to do about health care? And it remains. What do Republicans want to do about health care now?

            Sell something (UNSPECIFIED) “across state lines” is all that we hear.

          • Andrew Allison
      • Corlyss

        “your side has the Congressional majority to fund Medicaid to a proper level to make it work for both doctors and patients.”
        You disingenuousness knows no bounds. Your nitwits had the majority. They wrote the law. They could have written it in such a way as to “fund Medicaid to a proper level to make it work for both doctors and patients.” But they didn’t. Why didn’t they? Because then the CBO score would have made the politics of the bill untenable. The whole point was to reassure the public that they could have everything they wanted for nothing. So don’t gimme that crap about how “my side” is suddenly going to pull the rug. This was the Democratic scheme for decades: to pass generous benefits and make Republican administrations find some way to pay for them when the bills came due. Reagan had a nice counter-formula: “Lettem pay for their own damn programs!”

      • bannedforselfcensorship

        So, using this logic, the GOP could pass massive tax cuts, and then tell the Democrats they need to find spending cuts to fix the problem later on.

        • FriendlyGoat

          They may actually try that.

      • bannedforselfcensorship

        Also, just for fun, let’s examine Medicaid in California. California had a big budget problem. We could have cut salaries and pensions for state workers. (Just recently we had a assistant fire chief retire on a 900k pension, yes 900k not 90k.)

        But those are major voting blocs and donors. So instead, they cut Medi-Cal reimbursement rates. Yep, in order to keep state workers rolling in 1% style pensions, they balanced the budget on the backs of the poor. Sure, the poor weren’t told this. They still have Medicaid. Its just they will find fewer and fewer doctors to take it. Great deal for the politicians. Appear generous, and a way to blame “greedy doctors” if they are ever called on it. Greedy state workers never get the blame as they own the California political class.

        In case anyone is unaware, this was done at a time when California was entirely run by Democrats.

        So, any Democrats who want to blame evil, greedy Republicans who don’t care for the poor need to look in the mirror.

        • FriendlyGoat

          Firemen—– and more particularly, policemen—–are worshiped these days, you know. Are we hearing calls from conservatives to cut their salaries and pensions in St. Louis and New York?

  • Andrew Allison

    Of course Medicaid reimbursement rates will not plummet. Just as Congress has been delaying the nonsensical cuts to Medicare reimbursement in order to maintain access, they’ll spend what’s necessary to provide access to Medicaid recipients. Truth is, we actually have single-payer (the taxpayer) insurance for those not covered by employer-provided coverage, but it’s the love which none dare name. The bad news is that there’s no revenue to pay for it, so we’ll just keep borrowing until we’re all Greeks.

    • jimb82

      Not only do we have the permanent “doc fix” which keeps getting reappropriated every year, soon we will have to correct the $500 billion that Obamacare took from Medicare on the theory that HHS was going to “bend the cost curve” and be able to do more with less, freeing up $500 billion in unspecified savings in Medicare that could be diverted to Obamacare. Obviously,that is not going to happen, and the $500 billion is never going to be cut from Medicare. It will be interesting to see if it is still added to Obamacare, or if Obamacare remains permanently underfunded.

      As an aside, I have never met a liberal who can explain to what a cost curve is, let alone how one is bent.

  • S.C. Schwarz

    This is a feature not a bug.

    Step 1. Expand access. Don’t worry about costs.
    Step 2. Notice that costs are spiraling out of control.
    Step 3. Demand billions more. The Republicans won’t agree.
    Step 4. Propose single payer as a solution.

  • MarkE

    The showdown is bound to happen sometime. The people at the
    bottom don’t have enough money to pay the market price for medical care. These
    patients will need to be in an HMO-type arrangement. Doctors will bid for
    contracts to care for large groups of patients for a fixed price for a fixed
    period of time. The will force them to be both very efficient and to allocate medical
    care by the market costs of their resources (rationing from the supply side).

    The people who have enough money to pay for some or all of
    their care will decide what medical care is desirable and at what cost (rationing
    from the demand side). Their market based decisions will give information about
    what people really want when they have to pick-and-choose.

    Hopefully, the combined information from supply- side allocation
    and demand-side allocation will yield an incrementally improving situation.

    • FriendlyGoat

      Can you get Sarah Palin to describe the arrangement in your fifth sentence as “HMO death panels”? What else could the decision making inside “supply-side allocation” possibly be?

      • MarkE

        No, it just means they will be expected to do the best they can with the money and other resources the are given.

        • FriendlyGoat

          Same as Medicare, Medicaid and the PPACA.

          • MarkE

            The ACA (Obamacare) is essentially the Republican plan.
            However, Democrats passed it because it was the best they could get. There is
            an enormous amount of administrative discretion written into the law. The
            radical side would like it to fail and be replaced with some form of even more
            socialized-medicine and has influenced the implementation accordingly.

            If the Republicans can win the administrative branch, they
            may actually be able to make the plan work through changes in administrative
            policy and a few legislative tweaks. The general mechanism proposed above is
            one possible mechanism. “Better to light a candle….”

          • FriendlyGoat

            Is this why they made so much noise about “repeal and replace”, then just “repeal”, and then just “defund”.
            What useful tweaks have we ever heard of from the GOP that were not poison pills to collapse the whole thing?

          • MarkE

            I guess you would rather just “curse the darkness…” Takes all types.

          • FriendlyGoat

            Right now, the ACA is standing. Those who have been cursing it and trying to repeal it to darkness are not my side.

          • MarkE

            It is just that you comments in all strings are very negative, have the tone of polemic, and are always the last comment in every string. Is this a full time job for you?

  • f1b0nacc1

    Of course this is precisely the reason why most GOP governors wisely chose NOT to drink from the poisoned chalice, and declined to expand Medicare in their states. Those states that were foolish enough to go along with this scam are now saddled with permanently higher expenses in order to marginally increase coverage (not access, as most doctors are now refusing to treat Medicare patients, given the low reimbursement rates even prior to more cuts) and have very little to show for it otherwise.
    This whole debacle is a good example of how the Left often works. They create a crisis, demand ‘action’ on that crisis (which strangely enough is almost always the same prescription, massive new bureaucracy, and spending to fund it), then use their proposed action to extend government intrusion into the market. When it fails, they cry out that the Right is to blame because they didn’t provide enough support, and that only further infusion of resources and expansion of government is the answer. The truth of the matter is that here, as with similar ‘crises’, often the answer is to let the market work. It is NOT perfect (no system ever is), but the solutions tend to be more effective, protect basic liberties, and ‘gasp’! cheaper…

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