December 31, 2014
Column #1,740
The Inequities of Obamacare
By Mike McManus Obamacare (the Affordable Care Act, or ACA) “is riddled with
inequities,” writes my son, John McManus, a columnist with “Life Science
Leader.”
First, illegal immigrants may soon get Medicaid coverage financed 100% by the
Federal Government, “while 7 million American citizens who live below the
poverty line receive no coverage. Why? If the poor live in 23 states which
refused to accept 100% federal financing of the expansion of Medicaid, they are
not covered.
On the other hand, in those same states not serving the poor, a family of four
with an income up to $95,400 will enjoy subsidized coverage.
What sense does that make?
A Supreme Court decision gave states the freedom to not sign up for ACA. Many
states in the South and West refused to sign up, even though Obamacare provided
100% federal financing for Medicaid expansion for the first three years, and 90%
federal sharing afterward.
Traditionally, Medicaid has been targeted at women with minor children and the
elderly poor. States with lower per capital incomes pick up 27% of Medicaid
costs while the most affluent states cover 50% of its costs. The Federal
Government covers the balance. Those programs continue under ACA.
However, ACA expanded the coverage to married couples with children and single
individuals – if states signed up for Medicaid expansion. The result has been an
additional 9 million people getting health care for the first time.
The Urban Institute summarized the strange results. In states that expanded
Medicaid, two-thirds of the previously uninsured now qualify for Medicaid. The
median income of adults who qualify average $25,164 per year. And if that adult
has a family of four, their income could be as high as $95,400 – and still be
eligible for subsidies.
However, in states which did not expand Medicaid, adults who are ineligible have
an income averaging only $9,500 a year.
Stunningly, Obamacare gives subsidies to the upper middle class but not to many
of the poor.
In Texas a quarter of the population has no health coverage. And the poorest
people can’t sign up for subsidized coverage, because it is limited to those
above the poverty line.
The inequities could get even worse. A case will be ruled upon by the Supreme
Court in June, Pruitt v. Burwell, which will decide whether Americans living in
36 states which refused to set up state health exchanges – can receive any
subsidies under Obamacare. Presently, they are enrolled in the federal health
exchange, through the infamous Healthcare.gov website which was so difficult for
people to sign up for a year ago.
However, the ACA appears to limit federal subsidies to those states which create
state health exchanges – only 14 of which did so.
Finally, another fundamental problem of Medicaid is that its reimbursement level
is so low that most physicians turn away Medicaid patients. Obamacare provided a
temporary fix: a raise to the payment level of Medicare. That resulted in a 73
percent increase in payments.
“Just one problem,” my son points out. “The provision lasted for just two years
and expired at the end of 2014. Why? It was a budget gimmick to mask the true
cost of the program.”
Why has Obama been so silent on his own law, supposedly his greatest achievement
as
President? The Republican House has voted down Obamacare 40+ times. However, it
has failed to propose specific remedies. It is time for President Obama and the
new Republican Congress to act like adults and begin working together to rewrite
the law.
Obama also has to be willing to give Republicans something they want — like a
repeal of the individual mandate to buy health insurance There is no dialogue at
all and Obama has to initiate it.
Three major changes are needed:
1. The poor are the people who most need help, and should get it – regardless of
what state they live in.
2. If cuts are needed to rein in costs – upper income people should lose
subsidies.
3. Doctors should be given reasonable payments for their services.
The Affordable Care Act should be redesigned to serve the most needy at a
reasonable
cost.
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