Obamacare = Medicaid


I have been interested in health care reform for some time and have proposed a plan for reform. It is now too late for such a reform as Obamacare has engaged the political apparatus and sides have been taken. The Obamacare rollout was worse than anticipated and it was hoped that the Supreme Court would have mercy on the country, but that didn’t happen and it has been the law for two years.

What has it accomplished ? Well, the forecast drop in ER visits hasn’t happened. It also didn’t happen in Massachusetts when that plan took effect.

Wasn’t Obamacare supposed to solve the problem of people going to the ER for routine medical problems? We were told that if everyone had “healthcare” — either through the ACA exchanges or through Medicaid expansion — people would be able to go to their family doctors for routine care and emergency rooms would no longer be overrun by individuals who aren’t actually experiencing emergencies.

As it turns out, Medicaid patients can’t get appointments with physicians.

“America has severe primary care physician shortages, and many physicians will not accept Medicaid patients because Medicaid pays so inadequately,” said Michael Gerardi, MD, FAAP, FACEP, president of the ACEP.

The report — commissioned by the Emergency Medicine Action Fund — found that the median wait time to see a physician in the Medicaid managed care plan is two weeks but over one-quarter of the providers had a wait time of more than a month for an appointment.

When I was in practice, Medicaid (Known in California as MediCal) was notorious for paying poorly and very late. It took two years to get a payment of about 20% of the billed charge. What about now ?

Medicaid expansion—one of the keystones of ObamaCare—is anything but “a good thing” for the patients already relying on the Medicaid safety net. These truly vulnerable patients face second-class care as a new Medicaid expansion population is rushed to the front of the line. But what does this expansion population really look like? And what will be the impact of ObamaCare’s expansion on the needy patients who count on Medicaid to survive?

Able-bodied, working-age adults; almost all of whom (82 percent) have no children to support, nearly half of whom (45 percent) do not work, many of whom (35 percent) with a record of run-ins with the criminal justice system. ObamaCare has picked this population as the winner of its Medicaid expansion.

The population with employer-provided private insurance has been left alone until Obama leaves office.

The Patient Protection and Affordable Care Act (PPACA) employer “shared responsibility” mandate, originally set to take effect in January 2014 but delayed last year until 2015, will now be phased in so that midsize employers will not be subject to “play-or-pay” penalties until 2016, the Treasury Department announced on Feb. 10, 2014. The department issued a new final rule and related questions and answers on Employer Shared Responsibility Under the Affordable Care Act.
Treasury defines midsize organizations as those with the equivalent of 50 to 99 full-time employees, and, according to the agency, they represent about 2 percent of U.S. employers. Businesses with fewer than 50 full-time equivalent workers, which make up about 96 percent of all employers, are not subject to the play-or-pay provisions.

Interestingly enough, this has led to a new scandal involving Republicans.

Congress’s fraudulent application to the District of Columbia’s health exchange — the document that facilitated Congress’s “exemption” from Obamacare by allowing lawmakers and staffers to keep their employer subsidies. The application said Congress employed just 45 people. Names were faked; one employee was listed as “First Last,” another simply as “Congress.” To Small Business Committee chairman David Vitter, who has fought for years against the Obamacare exemption, it was clear that someone in Congress had falsified the document in order to make lawmakers and their staff eligible for taxpayer subsidies provided under the exchange for small-business employees.

Another example of why we have the worst ruling class in our history.

Now, the level of corruption has reached new heights and we are not even allowed to have Inspectors General, the traditional agency that kept the bureaucrats honest.

Then again, nondisclosure seems to be a habit with this IG office—ranging across years and different officials. USA Today reported in March that the office has conducted 140 health investigations since 2006 that had never been made public. Under growing pressure, the IG finally released them late last week, and the newspaper ran a follow-up noting that the cases ranged from “missed diagnoses” to “failures during surgery” to “misuse of funds” to “personnel issues” to yet more facilities that may be giving “questionable amounts or combinations of narcotics.” In many cases, said the newspaper, “the department’s chief watchdog trusted the VA to correct problems on its own.” Really?

That’s from one IG office. What about others ? Many don’t exist.

The episode is also raising questions about whether President Obama perhaps likes it this way. Mr. Griffin has been the supposedly temporary acting IG at Veterans for more than two years, an uncertainty that may in itself be feeding into office problems. He’s still there because Mr. Obama has failed to appoint a permanent head. In March, all 16 members of Mr. Johnson’s committee—Republicans and Democrats—wrote to Mr. Obama noting that there were 10 IG vacancies, including for such not-so-minor posts as Interior, the CIA and Export-Import Bank. They noted that there were nominations pending for only two of the 10, and requested he move quickly to fill the rest.

The ruling class does not appreciate attempts to inquire into its actions.

In the meantime, Medicaid patients wait.

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