Democrats have been working for years to keep alive the false narrative that Republicans “have no plan to replace Obamacare,” and the latest op-ed from Senator [score]Brian Schatz[/score] (D-HI) at USA Today is no different.
(The Republicans’ problem isn’t lack of ideas; it’s lack of will – in spite of the manifest passion of their voters for repealing the 2010 law.)
But Schatz’s opinion piece from Wednesday does have the virtue of summarizing a few actual proposals from Democrats to tweak Obamacare.
And the proposal of Senator Schatz himself is in a class all its own. Schatz’s ingenious plan is to offer to “let” anybody who wants to, buy Medicaid coverage for him or herself.
Schatz touts the benefits (footnote inserted by me):
Why Medicaid? Frankly, this program — already serving 69 million people — is underrated. It has a large provider network and the same positive ratings as private insurance but at a much lower cost to the government.* Based on partnerships between state and federal governments, Medicaid also gives states the flexibility to adapt services and models of care based on their individual needs.
Alert readers will recognize immediately the signal fact Schatz leaves out of his editorial. Medicaid is a welfare program. It’s a taxpayer-funded program that pays for some basic medical care for people who can’t afford individual private insurance, and aren’t covered by employer-provided plans.
People are being shifted to it not because they are “choosing” “insurance” on the “private market,” but because there’s an arbitrary requirement now that they demonstrate they are “covered” when they file their tax returns. Being enrolled in Medicaid checks that block. As long as their income-versus-insurance numbers make private insurance “unaffordable,” Medicaid is an option for them, without paying premiums.
Schatz is proposing that people who currently have private insurance, either individual or employer-provided, be “allowed” to “buy” Medicaid coverage instead, regardless of what they can “afford.”
This is basically like saying anyone who wants to can “buy” himself some unemployment insurance from the government – or buy an EBT card or buy some Supplemental Security Income. Hey, just pay a premium in advance, and then, if you need it, it’s there!
Except – it’s already there. Like the EBT card and the unemployment and SSI benefits. If you lose your medical insurance plan – for example, if you simply can no longer afford it, or your employer can’t afford to keep a group plan in place, and pays the Obamacare fine instead – what do you think happens if you show up at an emergency room, insurance-less, with a broken limb? That’s right: the hospital files with Medicaid (and/or a taxpayer-funded state program, much of the funding for which typically comes from federal Medicaid dollars) to cover your treatment cost.
Medicaid works like welfare. Because it is welfare. It’s there, and you get the benefits, without you paying a personal premium in advance.
What fool would switch from paying for private insurance to paying a premium for Medicaid?
Even if you did make such a curious switch, you’d almost certainly find that Medicaid either doesn’t cover things you’re used to that your old insurance covered, such as specific drugs and procedures, or reimburses them so much less that providers won’t offer them to Medicaid patients.
Moreover, you’d find on average that only about half of care providers in your area take Medicaid patients – and only about two-thirds of that half are accepting new Medicaid patients.
So even if recent statistics show that about half of your area’s providers accept Medicaid, you still face a pool of less than 40% of all the providers in your area who are willing to take you on as a new patient.**
Senator Schatz is excited to think that “letting you buy” Medicaid coverage would enable you to buy “insurance” affordably:
If my bill became law, states would be allowed to open up Medicaid to give every family access to health insurance on the individual market — and it would cost less than a tenth of their income. The 157 million Americans who already have insurance from their employers could decide whether they want to keep it or move over to a Medicaid plan.
But I’m looking at this proposal and thinking, For this I should pay money?
(A growing pile of evidence indicates, moreover, that the expansion of Medicaid under Obamacare is accelerating the long-term trend away from provider acceptance of Medicaid. See here, here, here, here, here, here, here, here, here, and here, for example. The level of reimbursement has always been too low to cover the cost to the provider of handling the patient load. But with more people now losing their private insurance, and being funneled into Medicaid, many providers just can’t make the books balance anymore. They’re also finding severe Medicaid payment backlogs in a number of states. Putting even more people on Medicaid will only make that worse.)
The, er, ingenious part of Schatz’s proposal is getting suckers to voluntarily fork over “premiums” to a medical welfare program.
There probably is one born every minute. I doubt that there are 157 million of them out there; I really do. It’s a totally brilliant plan, to try to get unwary Americans to start sending new money to Medicaid by marketing it as “health insurance”: just like their private plan only cheaper. But I don’t think it would take much for the overwhelming majority of Americans to see right through it.
* Nothing at the link here appears to demonstrate that the cost of Medicaid to the government is lower than the cost of private insurance to the government. In fact, even the statement about halfway down the page that annual Medicaid spending “is projected to have decelerated sharply” from 2015 to 2016 – a projection for which actual figures are not offered – is deceptive. A few lines later, we learn that spending on Medicare and Medicaid will then turn around and drive overall growth in health spending in 2018-19. Spending on Medicare and Medicaid can only come from the taxpayer – i.e., government; this pair of statements establishes nothing about the comparative costs of Medicaid and private insurance to the government.
** Articles like this one and this one were assembled earlier in 2017 to demonstrate that Republican critics of Obamacare are wrong on their claims about Medicaid – specifically, about the limited number of providers who will accept it. What the information at the links actually shows is that only a minority of providers will accept new patients.