My concept of Obamacare has been that it is a transition period to a single payer that will be Medicaid for everybody. Belmont Club (Richard Fernandez) seems to agree.
One of most fascinating things about the failure of Obamacare is it has occasioned the rise of private exchanges, which are now on track to completely dwarf the public Healthcare.gov exchanges. Obamacare is becoming Medicaid for all. That is where all their expansion is coming from, the metal plans it offers, not so much.
The abolition of employer-provided insurance has led companies to simply give workers money to purchase their own health care on a private exchange. Urgent care clinics are booming because they charge much less than Obamacare network prices when a policy holder has not yet reached his deductible. What is repealing Obamacare is that people are working around it, according to their preference. Vermont, for example, is creating a single payer health care system. The Left approves, but it is a rejection of Obamacare just the same.
Thus, private money offsets legal tender. Private security replaces public safety. Private armies replace the United States Armed Forces. Private exchanges replace public exchanges. In the end, only the poor will be left with the public stuff.
I have been of this opinion since the beginning.
At least 2.9 million Americans who signed up for Medicaid coverage as part of the health care overhaul have not had their applications processed, with some paperwork sitting in queues since last fall, according to a 50-state survey by CQ Roll Call.
Those delays — due to technological snags with enrollment websites, bureaucratic tangles at state Medicaid programs and a surge of applicants — betray Barack Obama’s promise to expand access to health care for some of the nation’s most vulnerable citizens.
As a result, some low-income people are being prevented from accessing benefits they are legally entitled to receive. Those who face delays may instead put off doctors appointments and lose access to their medicines, complicating their medical conditions and increasing the eventual cost to U.S. taxpayers.
Democratic lawmakers who have promoted the law’s historic coverage expansion are wary of acknowledging problems that hand opponents of the Affordable Care Act another rhetorical weapon, said Robert Blendon, a professor at Harvard University School of Public Health and Kennedy School of Government.
That was a year ago.
What now ? The Heritage Foundation has a post about the Medicaid expansion that is Obamacare.
Heritage research shows 40 of 50 states would see increases in costs due the Medicaid expansion. If all states expand, state spending on Medicaid would increase by an estimated $41 billion by 2022.
The costs are being shifted to the states. Will that work ?
Analysis by Heritage shows that by 2022 any projected state savings are dwarfed by costs. Moreover, these projected savings assume states will further reduce payments to hospitals and clinics for uncompensated care. But, as Heritage’s Ed Haislmaier points out, it is more likely that hospitals will lobby state legislatures for more money rather than less.
It all depends on cutting reimbursement to providers. Is that likely to increase access for anyone ?
What it will do is shift those who can afford to pay into a parallel system of cash clinics and practices, Which I have predicted.
There have been other suggestions but it is unlikely that any great reform would be tolerated now after the failure of the Democrats’ attempt.
Instead, I think the Republican Congress should pass legislation to make Obamacare voluntary and let the ,market works things out.