7.2 Million More Americans Dependent on Medicaid since Obamacare Opened
The Center for Medicare & Medicaid Services (CMS) has just released more data corroborating our previous conclusion that Obamacare is mostly an expansion of welfare dependency:
The 48 states reporting both June 2014 enrollment data and data from July-September 2013 report total enrollment in June of over 65 million individuals, and July-September 2013 average enrollment of 58 million. For June 2014, we are reporting growth of 7.2 million compared to July-September 2013…
What is really remarkable is that the government thinks this is something to be proud of. It is a far greater number than the increase in those enrolled in individual plans (even with Obamacare subsidies), and will impose a significant drag on employment growth as long as Obamacare’s Medicaid expansion persists.
The other problem with this is that there are not enough physicians to take care of these patients. Medicare parity was only on the table for a year (why only a year makes no sense), now it is up for renewal in Congress. If something isn’t done to make the payments more palatable, medical care under Medicaid will continue to be given in ERs.
This is a serious problem. I don’t have the perfect solution. It would have to be multifaceted. Primary care physician fees for Medicaid providers will have to be increased if state really expect doctors to treat Medicaid patients. In addition, patients will need to be counseled on physicians in their area and possibly assisted in selecting one. Finally, part of the process will necessarily involve costly-copayments for Emergency Room visits that don’t result in an admission.
I am not quite tracking why the expansion of Medicaid should affect employment.
I just got finished enrolling one of my sons in Medicaid. He is a cook at a restaurant. Near as I can tell, the restaurant would much rather have him on Medicaid versus being forced to insure him.
Medicaid is funded by income taxes, so the employer does not directly pay for it. Wealthy citizens of all ages pay for it. I suppose that is a drag on employment but not a major one.
Now if my son gets a better job and makes $21,000 versus $14,000, he would lose Medicaid. That is an ugly problem, but is that a drag on employment?
It is a drag on his increasing his monetary wages, plus reduces (but does not eliminate) incentives to work.
John I think you are correct regarding the seemingly disproportionate expansion of Medicaid enrollment. But I think that was inevitable, because Medicaid had failed to cover the people it was designed to cover – the poor.
In October 2006, the Kaiser Family Foundation Commission on Medicaid and the Uninsured released this Issue Paper:
http://www.kff.org/uninsured/upload/7571.pdf
The Issue Paper cites Federal Census data reporting that the estimated number of uninsured stood at 46.2 million, or about 17.9% of the under-65 population. This Paper thus provided additional support for the expressions of concern that “one out of every 6 Americans is uninsured”.
But wait a minute. Statements like that only reflect the average. Even an accurate average says nothing about the distribution of the population.
It is accurate to say that “one out of 5” persons on the face of the earth is Chinese but that does not tell you how many Chinese live on your block. Fact is, the overwhelming majority of Chinese live in China. Similarly the uninsured don’t simply comprise “one out of every 6 Americans”. Fact is, the odds of being uninsured are hugely driven by poverty.
The Kaiser Issue Paper confirmed this fact, which prior surveys had also consistently found. And it stands to reason – – the very poor tended not to have regular, full-time jobs that offer employer-based group insurance; they often did not sign up for employer-based insurance even if eligible, because of the cost; and they could not afford to purchase individual insurance.
Table 1 in the Issue Paper shows that people below 2X’s the federal poverty level comprised about 65% of all uninsured, non-elderly Americans in both 2004 and 2005. For people below 2X’s the FPL, the uninsured rate was 32.3% in 2004 and 33.3% in 2005.
These findings raise questions for Medicaid. Why was Medicaid failing to meet the needs of so many of our most impoverished citizens??? Aren’t these the people that Medicaid was created to serve?? How can Medicaid be falling so far short of meeting the goals for which it was established??? The KFF Commission on Medicaid and the Uninsured never raised these questions in its Issue Paper.
If all the nonelderly below 2X’s the federal poverty level had been enrolled in Medicaid, the proportion of uninsured Americans would have been only 6% – not 17.9%.
Did the government proceed to seek solutions to underlying problems? Say, our depressed economy that produces too few jobs? Or the high cost of medical care that is the chief obstacle to obtaining care in the first place? Nay, sir. Instead it pretended the problem is insurance. It expanded Medicaid. All better now. See?
Thank you. One of the issues discussed at this blog is that uninsured, Medicaid-eligible people who are healthy have no incentive to enroll in Medicaid, because they can sing up at any time – which is not the case in Obamacare exchange plans.
Because of the big marketing push in Obamacare’s open enrolment, lots of Medicaid eligibles signed up, but that will peter out.
Excellent point John. But these people are still not getting medical care. Nor are any of the social obstacles to better health being addressed.
Note to John Fembup:
I think you are underplaying the fact that Medicaid eligibility levels have been set by state governments.
Your words imply that “government’ failed to make Medicaid effective.
I think you have to be more specific. If Mississippi or Texas set the eligibility limit at about $10,000 of income, and never included single adults, then of course many of the insured went uncovered.
This was not a failure of government. Medicaid has never been federalized. This was a decision of stingy and racist state legislators, who have been determined not to make life too comfortable for minorities. These states have silently pushed minorities to move up to New York, Illinois, et al, where liberals could try to handle them.
Bob Hertz says “This [Medicaid] was not a failure of government”.
Piffle, sir.
Also piffle is your suggestion that Texas and Mississippi and the other states are not “governments”.
btw, you seem to imply that the American Congress and Executive branches over the years were either (a) “racist” for their acquiescence in the larger Medicaid failure, or (b) powerless to do anything to fix Medicaid or (c) both. If you mean something else, perhaps you can explain.
Note to John Graham:
This is not a huge deal, but I still think you are wrong to state that Medicaid causes a shrinkage in jobs, for these reasons:
a. Medicaid is not welfare. You cannot stay home and just goof off if you have Medicaid. You will still starve or close to it or become homeless if you have no income from work.
b. When people get Medicaid, which is free, they can stop paying for health insurance or for episodes of care.
This gives them a little more money to spend at Walmart and McDonald’s. This leads to small increases in the number of jobs at Walmart and McDonald’s.
c. Let’s say you are right and that some workers will choose not to apply for better jobs so they can keep their Medicaid.
Most unskilled jobs have a surplus of applicants. If ten workers decide not to apply for a $21,000 job, big deal. 100 other people will still apply for that job.
d. Finally, expanding Medicaid will have to create some new jobs in health care.
This will offset job losses elsewhere to some degree.
I was hospitalized for 5 days a few years ago. I was privately kind of stunned at how many people were employed serving food, mopping floors, and scrubbing toilets at the hospital. I sensed (right or wrong) that the hospital where I stayed was kind of quiet WPA.
Thank you.
a) Of course Medicaid is welfare: Like SNAP or housing assistance. It is one piece of the complex. There are millions of people in this country with no income from work, and the welfare system traps them. It has been exhaustively studied since Losing Ground, by Charles Murray, published in 1984.
b) And the money taxed from others to finance welfare reduces their budgets, which they would have either spent or saved.
c) There is not a fixed supply of jobs. Good public policy incentivizes investment and employment broadly.
d) We could tax 100 percent of incomes and allocate 100% of GDP to health spending. That would make 100% of the workforce dedicated to healthcare. The only place to get a bite to eat would be at the hospital – where, as you point out, there is already lots of food service!
NOte to John Fembup:
As for “acquiesence” in racist policies….Franklin D Roosevelt declined to pursue an anti-lynching bill in the 1930’s, in order to be sure that Southern Democrats would support unemployment comp and Social Security. Was this racist, or just a political choice?
As for whether Washington was powerless to make Medicaid more generous — actually, I would have to say on balance that they were and are powerless.
Look what happened on the Roberts court in 2012.
The federal government does lack the practical power to make Medicaid uniform.
This may be a good or a bad thing, but it is my point.
Bob Hertz said “The federal government does lack the practical power to make Medicaid uniform . . . This may be a good or a bad thing, but it is my point.”
And you may also be correct. But regardless, it is government that must bear the blame for creating the failure called Medicaid, and for compounding that failure with yet more ill-conceived programs, designed to spend more money but not touch the underlying problems. That’s my point.
And I think my point is valid whether one believes, as you say you do, that “government” means the Feds only; or whether one believes, as I do, that “government” also includes the states.
btw, I would say your view of government programs (state and federal) is quite similar to mine: they are Frankenstein-like creatures that government has the power to create, but too often not the power to control. That should be a sobering insight for voters. It is a frightening insight into our likely future under Obamacare.