The health care insurance exchanges championed by the Obama administration are designed to control health care access at the state level. They are invasive and make it impossible for governors who want to set up flexible exchanges that deliver choice and quality care to do so.
Individuals buying insurance through a market place is not a bad idea, but in the case of the Affordable Care Act, there is a 2,700 page statute governing number of plans that can participate in the exchange making it virtually impossible for a state to design an exchange suited to the needs of its vulnerable populations. To date, 17 states and the District of Columbia have agreed to set up their own exchange and 33 have ceded some, if not all power, to the federal government to run their state’s exchange, yet no one can know for sure how much they are going to cost. The exchanges are supposed to be up and running by October 1, none have been seriously beta-tested, so it is all but certain they are a recipe for disaster.
Now, many states are currently grappling with the decision of whether or not to expand Medicaid for citizens who have incomes up to 133% of poverty, as allowed by the Affordable Care Act.
Republican governors who have caved on the Medicaid expansion issue are under fire by conservatives who don’t necessarily understand the political realities of being among the non-expanders. The dramatic rhetoric evoked by liberal Democrats has succeeded in blurring the lines between positive and negatives rights and turning government into the distributor of rights in health care, rather than the doctor and patient.
Conservatives have been unable to package the idea that treating health care as a right distracts from the real distributive injustices in our health care system allowing liberals to rely on these emotional appeals condemning hundreds of thousands more citizens to Medicaid, a program in dire need of reform as it can be worse than having no insurance at all.
Governors are also caving to industry players naively thinking that by expanding Medicaid the problem of uncompensated care will be solved. Yet in reality, the Medicaid expansion is nothing but a bailout for blue states that will push the system to collapse by costing all states more in the long run.
Industry players think that by expanding Medicaid they will be able to re-coup the cost of taking care of uninsured and under-insured, and those who realize this is not a long-term solution see that they will be able to make money in the short term with more customers.
Truth is, on October 1, 2013, Obamacare cuts Disproportionate Share Hospital (DSH) payments by 75%. These payments are made to hospitals that provide emergency care to everyone regardless of their ability to pay under EMTALA. Industry players, compensated by Medicaid below their costs, believe that they can make up for this 75% cut by increasing their volume (seeing more patients) undermining the combined goodwill effort of industry and government to reward value over volume in health care.
Even with the feds generous match rates, the expansion will cost all states at least $118 billion through 2023 and will crowd out important funding for budget items such as education, public safety and transportation while there is no guarantee that the federal match will continue past 2016. It’s a bait and switch that in the end will make it harder for the most vulnerable among us to get care.
Bottom line, a Medicaid card clearly will not guarantee access to care, and both GOP and Democratic governors alike shouldn’t condemn more citizens to a program in dire need of reform.