Where 16 Million Uninsured People Will Get their Insurance under ObamaCare

This is from a James Madison Institute backgrounder by Michael Bond:

“When compared to patients with HMO or private insurance, Medicaid patients were less likely to receive aspirin, beta-blockers, clopidogrel, and lipid-lowering agents. Medicaid patients were also less likely to receive dietary counseling, smoking cessation counseling, and referral for cardiac rehabilitation. Gaps also existed for acute care. Delays were observed for Medicaid patients in the time to first electrocardiogram and in time to cardiac catheterization and revascularization when these procedures were performed. Medicaid patients had higher in-hospital mortality rates (2.9 percent vs. 1.2 percent), and after adjustment, the risk for death was approximately 30 percent higher in Medicaid patients compared to those with HMOs and private insurances.”

The ER rate for Medicaid (80.3 visits per 100 persons) was almost twice as high as other medical groups. Assuming Medicaid beneficiaries gain access to providers, they receive inferior quality of care compared to other patients. Medicaid beneficiaries also face more difficulties scheduling adequate and timely follow-up care after initial treatment for an illness than those with private insurance.

Comments (16)

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  1. Larry C. says:

    I think there are going to be 16 million unhappy people, to say nothing of the 50 million so so current Medicaid enrollees who will now have more competition for a dwindling supply of doctors who are willing to see them.

  2. Joe S. says:

    Looks bleak.

  3. hoads says:

    But Obamacare is going to legislate healthcare equality. Doctors will be bludgeoned to prove that they are achieving government dictated “standards of care” (which will be meeting criteria on a checklist that don’t actually improve care but do meet government “standards”). And then with bundled payments, doctors will be forced into bedside rationing such that the sickest won’t get the care they need (again–government “standards” will be met) so that medical care can be “redistributed” from the sicker to the healthier. After all, the healthier will always outnumber the sicker and can be assured to make it to the voting booths. It will be healthcare mandated to the lowest common denominator.

  4. artk says:

    The problem with Medicaid has been well know for years. It’s provider reimbursement rates are a crime. The reason for this is simple, it’s a program for the poor, and the poor traditionally don’t have political clout in this country. The fix is simple, make it pay the same reimbursement rates as Medicare.

    As far as the 16 million additional enrollees, it would be better if Medicaid enabled the poor to have the same access to medical care as the elderly, but poor access is better then the current situation they currently face.

  5. Tom H. says:

    Interesting comment by artk. Why do you suppose ObamaCare is putting all these people in a program that pays well below market? I don’t know that they will be better off than they would be otherwise. In Massachusetts, I don’t believe the newly insured have any better access to care than they did before reform.

  6. Ken Turnage says:

    Yes John, you are probable correct in your statements but I don’t remember it ever being said that these uninsured would have a Cadillac plan provided to them. I think the intent is to at minimum provide a basic plan to them. It beats having none at all. But you probably wouldn’t understand what that is like.

  7. John Goodman says:

    Actually, Ken, it doesn’t necessarily beat having nothing at all. Medicaid is overall only marginally better than being uninsured and if you want an appointment with a doctor your chances are apparently better if you pay out of pocket.

    What Medicaid definitely doesn’t beat is being able to take the same dollars and enroll in a private plan.

  8. artk says:

    John sez” “want an appointment with a doctor your chances are apparently better if you pay out of pocket”

    The current Medicaid program is limited to people at the poverty level. That’s 10,000 a year for an individual, or less then $200/week. Do you think that someone with that income has the $250 to pay what the average family practice physician charges, no less any additional charges for tests or medication. You should do an experiment. Start the week with $200 in your pocket, have your wife hide all your credit and debit cards and your checkbook. That has to pay for all you food and other expenses for the week, if you run out, you go hungry. Then tell me how someone at the poverty level can pay out of pocket to see a physician.

  9. Virginia says:

    The Medicaid/Medicare reimbursement discrepancy is the biggest joke in America’s health care system. Despite our commitment to “fairness,” we effectively have two different stratas of public care.

    It also implies a lot about the future of so-called “nationalized health care.” Are senior citizens more important just because they’re older? Or is it because they vote more?

    Goodman’s point about private health care is pretty profound. The government already sanctions treating poor people like second class citizens. But poor people (and immigrants) can show up at any Walmart clinic in the country and get the same care that you or I could get. It’s true that $200 in your pocket is barely enough money to live on, but when your options are 1) searching for a physician that will agree to take a business loss in order to see you or 2) paying to visit a nurse practitioner or AM/PM Clinic, something seems better than nothing.

    For as much as we want doctors to be altruistic, they just can’t be. They run a business like everyone else, and as long as we’re not paying them enough to treat poor people, we’re going to see a lot more Medicaid patients left out on the curb. (I also think Medicare will reach that point as well, most likely when the Boomers have too many health problems to go out and vote.) Let’s hope someone develops a business model where Medicaid patients can control their own destiny. I for one will look for the answers on the free market.

  10. Linda Gorman says:

    On paper, Medicaid offers better coverage than any private plan or Medicare, and it simply is not true that Medicaid is limited to the poor.

    In 2008, almost 9 percent of Medicaid enrollees had incomes in excess of 300% of the poverty level. That’s $31,200 for a single person, $84,800 for a family of 4. Incomes between $14,000 and $31,200 made up 24.5 percent of the Medicaid distribution. Given that Medicaid pays for roughly 40% of the babies in the country, a lot of young women on Medicaid are probably not living independently.

    People with incomes at 130% of the poverty level are eligible for food stamps, housing subsidies, child care subsidies, and transportation assistance. They can receive medical care for free or at vastly reduced rates at any of the federally qualified health care clinics. With food, housing, medical care, transportation, and health care spending taken care of, $200 a week is doable.

    Finally, poverty measures only count cash income. Programs like Medicaid are excluded.

  11. Art says:

    What most fail to realize is that the number who will receive lower quality care won’t be limited to Medicaid, unless the practitioners and facilities limit their patients to Medicaid, as may be the case in government clinics.

    In addition adding 16 million more to Medicaid roles will lower the existing Medicaid quality even further since there will be no greater number of physicians serving that care area than there are now and perhaps there will be far fewer!

    And then there are a few who believe that Medicaid isn’t limited to the poor and perhaps also believe that all states define eligibility based on poverty considerations.

  12. John Goodman says:

    I was in Massachusetts a few months ago, and a woman cab driver on Mass Health (Medicaid) told me she went down a list of 20 doctors before she found one who would see her.

    She was not going through the Yellow Pages. She was going down a list that Medicaid gave her!

  13. Devon Herrick says:

    Mike Bond’s analysis suggests the few Medicaid clinics willing to see Medicaid patients will have to rush them through much faster for enrollees to actually have access to a doctor.

    Let me explain. To squeeze more volume through a fixed space you have to increase the velocity? The formula for the volumetric flow rate in fluid dynamics is calculated as Q = A × C × cos0;

    Where Q = the volumetric flow rate
    A = a given area and
    C = the velocity
    and cos = angle of the perpendicular direction from A

    In other words, Medicaid clinics may have to install a drive-through window like McDonalds.

    Drive-throughs may work for fast food but I’m not so sure they will work for medicine.

  14. Tonia says:

    How does a single adult person that is middled aged qualify for Medicaid? I have no children, am 40 years old, attending school for my Bachelors in business, a licensed bail bonding agent, but without much income and barely making it. I don’t seem to fall into the categories listed to obtain assistance, even though I do not have employment. Correct me if I am wrong, but Medicaid is limited to the elderly, people with children, children, or someone that is disabled and not just poor and down on their luck with the bad economy. I am going to go in the morning to find out some of the answers and what the health care reform means to me and if I cannot get help, then how would I be able to pay a fine for being uninsured if I cannot pay to get insured.? I DUNNO? I do know that many people are in dire straits and the economy is not getting better.

    Thank you,
    Tonia in Charlotte NC

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  16. Sonja says:

    Medicaid doesn’t pay what people think it does. My son had a severe cross bite, that caused migraines, congestion, and other problems. The only way to fix it was to have a device put into his mouth to spread his palate, then braces, then retainer…. medicaid said NO WAY! Now this isn’t cosmetic, it is a medical problem but they wouldn’t pay for it. The dentists and orthodontists I have spoken with says there are those out there worse off than my son that medicaid will not cover as well. Medicaid is a joke. After saving up for several years and the kindness of families on both sides, I finally got up the money to have this corrected. Do not think for one minute that Obamacare is going to help these kids out.. it will not. Families will still be stuck with bills like this AND a sorry plan that only suits those that can afford what they do not pay. I used to have insurance. A strong believer in insurance; but until we open up the freedom to chose our insurance carriers in an OPEN MARKET, across state lines, you can forget affordable healthcare with any quality involved! Basic math rules on this one. People need to start using those rules instead of ideologies that go absolutely no where.