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Obamacare-Medicaid Connection: Back Door to a National Single Payer Plan?

President Obama is seeking to expand federal funding to states that expand medicaid eligibility.

One of the key results of the Affordable Care Act (ACA, better known as Obamacare) has been an explosion in Medicaid enrollment.  About 12 million people have signed up for Medicaid under the program. Some observers believe that the Medicaid-expansion provisions of the ACA were a stealth effort to lay the groundwork for a one-payer system.

A revealing study by the Henry J. Kaiser Foundation  notes that  “policy changes introduced by the Affordable Care Act (ACA) have been driving Medicaid enrollment and spending growth…Medicaid enrollment and spending increased substantially in FY 2015, the first full year of implementation of the major ACA coverage expansionsAcross all 50 states and DC, Medicaid enrollment increased on average by 13.8 percent in FY 2015, largely due to the ACA coverage expansions.”

Those states that accepted Medicaid expansion under the ACA experienced Medicaid growth far in excess of non-expansion states. The Kaiser study found that “Expansion states reported Medicaid enrollment and total spending growth nearly three times the rate of non-expansion states. A total of 29 states were implementing the ACA Medicaid expansion in FY 2015, up from 26 states in the previous year (FY 2015 additions include: New Hampshire, Pennsylvania and Indiana.)

“Across the 29 expansion states in FY 2015, enrollment increased on average by 18.0 percent and total spending increased by 17.7 percent; both enrollment and spending growth were driven by increases in enrollment among adults qualifying under the new expansion group. Of the 29 states expanding Medicaid in FY 2015, more than half (17 states) noted that enrollment initially increased faster than expected.”

“ Over two-thirds of expansion states reported that per member per month costs for the expansion population were at or below projections.  Across the 22 states not implementing the Medicaid expansion in FY 2015, enrollment and total spending growth was 5.1 percent and 6.1 percent (respectively), much slower growth compared to the expansion states. Increased enrollment among previously eligible parents and children was the primary reason cited for enrollment growth in non-expansion states.”

Obamacarefacts.com otes that “ObamaCare’s Medicaid Expansion Could Insure 21.3 Million Americans in the Next Decade. ObamaCare Medicaid Expansion is one of the biggest milestones in health care reform. “
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A Heritage review  found that the increased Medicaid enrollment under Obamacare has been accompanied by declining enrollment  in employer plans.

A Washington Examiner  review emphasizes that “There are 393 appearances of the word ‘Medicaid’ in the legislative text of Obamacare. The expansion of Medicaid itself is authorized in Title II, Subtitle A of Obamacare — a section called, ‘Improved Access to Medicaid.’ The Medicaid expansion is one of the main two ways through which Obamacare expands insurance coverage. By 2025, the Congressional Budget Office projects that Obamacare will add 14 million people to Medicaid. The Medicaid expansion will account for $824 billion (or slightly more than half) of Obamacare spending over the next decade, according to the CBO.

“It’s also worth noting that Medicaid is the one aspect of Obamacare that both left and right agree is explicitly a single-payer system. The logical implication of Kasich’s position of boasting about rejecting setting up a state-based exchange while expanding Medicaid is that Obamacare would have been better if it simply expanded single-payer healthcare in the U.S. instead of monkeying around with regulated exchanges that featured private insurers.”

Jeff Reynolds, writing in Freedomworks states that  “the expansion of Medicaid under Obamacare has come with all sorts of surprises and unintended (or perhaps intended) consequences. Medicaid expansion creates a two-tier medical delivery system that forces all but the most well-off into a single-payer system. Indeed, Obamacare’s similarities to Great Britain’s NHS are becoming more apparent. Another way this is being accomplished: the removal of asset limits for Medicaid qualification.

“In addition to the huge cost to the taxpayers, there is much to worry about in expanding Medicaid, particularly in the quality of care, notes Reynolds. “There is also strong evidence Medicaid provides substandard care. The Manhattan Institute’s Avik Roy wrote in 2012, ‘Medicaid patients were almost twice as likely to die as those with private insurance; their hospital stays were 42 percent longer and cost 26 percent more.’

“Many doctors refuse to accept Medicaid patients because payments are low. John Goodman of the National Center for Policy Analysis told Fox News, ‘One woman in Boston who was in Medicaid said she had to go through a list of 20 doctors before she found one who would see her.’ He adds, ‘I asked if she was going through the Yellow Pages,’ and she said, ‘No, I’m going through the list of doctors Medicaid gave me.”