OBAMACARE'S IMPACT ON MEDICARE, MEDICAID AND DEBT
As with all major entitlement reform programs of late, Obamacare came with rosy predictions that it would be affordable and would expand, not reduce, coverage. Indeed, its very purpose was to cause some 30 million Americans said to be uninsured to receive health insurance for the first time. Based on recent Congressional Budget Office predictions, however, Obamacare will not be affordable for the government or for seniors and will not offset health insurance losses. Indeed, the program will cost at least double its projected $940 billion price tag, will leave 30 million people uninsured by 2022, and will increase the cost of and reduce the availability of services for seniors on Medicare. Obamacare is, in short, another federal boondoggle and, indeed, worse than a waste of money, it promises to destroy the quality and diversity of medical care in America, undoubtedly contributing to a rise in preventable illness and deaths. Were it not for its imposition of $1 trillion in new taxes over the next decade, Obamacare would appear presently as an addition to the federal deficit. Likely, as the true costs of the program come to be known and as the costs of implementation are calculated into the equation, Obamacare will add to the deficit despite its tax increases.
CBO has revised its estimate of the cost of Obamacare. One year ago, the figure of $940 billion was often quoted by the President, leaving serious economists disgusted because the figure arose from double counting and manipulation of the start date from its actual kick-off in 2014 to a false start date of 2010 (thus diminishing the 10 year estimate of costs). Now, as the program comes closer into view, the CBO estimates are beginning to rise, and rise again they likely will in the years to come. Rather than $940 billion, CBO now predicts the cost will be double that, at $1.76 trillion, by 2022.
Within the White House, considerable angst attended the President’s decision to favor a universal health insurance mandate rather than a single payer system of socialized medicine. Those individuals were buoyed, however, by Obamacare provisions that permitted high risk individuals to be shifted from private insurers to state funded agencies through the exchanges and by Obamacare provisions that compelled a significant increase in the states’ Medicaid programs. Although the Supreme Court neutered Obamacare’s Medicaid expansion program by effectively making it volitional, the advocates of socialized medicine are still having a field day because CBO expects the failure of several states to buy into the exchanges (a very bad deal for states, one guaranteed to exacerbate their economic woes) will contribute to a ratcheting up of the number of people falling into Medicaid’s ranks. Some 2 million people will not be served by the exchanges and, so, will be added to Medicaid over the next few years. By 2022, CBO estimates that 17 million will be added to Medicaid.
Obamacare will thus grow by enormous numbers the universe of people on Medicaid. Medicaid pays physicians about 56% of the amount private insurers pay. Because reimbursement rates are so low, many physicians refuse to provide care to Medicaid patients. Those patients typically end up without care longer than the privately insured, and they also typically receive less care overall and less specialty care in particular than the privately insured. Consequently, rather than improve the quality of care for the neediest of Americans, Obamacare will reduce it by substantially expanding the number of people on the inferior Medicaid program. In a recent policy study for The Heritage Foundation, Kevin D. Dayaratna surveys recent studies on the quality of care provided to Medicaid patients.
One series of studies found children on Medicaid received poorer outpatient care, less access to specialty care, less access to boys’ urologic care, more denials of appointments, and longer waiting times than children covered by private insurance. Another series of studies found adults on Medicaid likewise suffer from inferior care. One study surveyed showed that women on Medicaid were diagnosed with breast cancer at more advanced stages of the disease than women on private insurance and had higher risks of death than women on private insurance. Another found that Medicaid patients diagnosed with colorectal cancer not only had higher mortality rates but also received less cancer directed surgery than privately insured patients. Still another found survival rates for those diagnosed with colorectal, lung, prostate, and breast cancer in Kentucky to have higher survival rates if they were on private insurance rather than Medicaid.
Seniors on Medicare are also getting hit hard by Obamacare. In a Heritage Foundation Issue Brief, “Obama’s Medicare Plan: Seniors Will Pay More,” authors Robert E. Moffit, Rea S. Hederman Jr., and Alyene Senger report that between 2012 and 2017, “seniors’ standard Medicare Part B monthly premiums will jump from $99.90 to $128.20, while their Part B. deductibles will rise from $140 to $180.” In addition, their “hospital deductible will increase from $1,156 to $1,336, while their daily hospital coinsurance will climb from $289 to $334.”
Obamacare mandates $716 billion in cuts from the Medicare program by 2022. Those across-the-board cuts reduce payments to hospitals, nursing homes, home health agencies, hospice agencies, and Medicare Advantage plans. The effect of such major reductions is a lessening in the degree, kind, nature, and quality of service provided to seniors, as providers endeavor to find means to survive the reductions and prioritize service to those in categories of greatest need. At the same time, Medicare Part D prescription drug coverage will carry with it higher costs for seniors.
Moreover Obamacare is contributing to the escalation in the costs of health insurance and forcing employers to drop plans altogether. CBO estimates 4 million Americans will lose their employer sponsored health insurance over the next few years.
Obamacare statutory and regulatory mandates also define what constitutes a plan qualified under the program. The plan qualifications define insurance parameters which, in turn, define the standard of care for the provision of medical services. The system largely mirrors that currently provided by Medicare. Consequently, this achieves a bureaucratization of the practice of medicine, limiting physician options and choices to those deemed medically reasonable and necessary (and therefore compensable) under the program. Obamacare thus supplants independent professional judgment of physicians in response to patient needs with a one-size fits all bureaucratic approach to the practice of medicine in which treatment options are dictated by the insurance companies as proxies for the Department of Health and Human Services.
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In sum, as Obamacare comes into clearer focus for Americans they will realize that it has effected fundamental changes in the nature of their relationship with the federal government. Advertised as an affordable means to increase the provision of quality care to the uninsured, Obamacare is proving itself unaffordable to the government and to all Americans and to effect a significant reduction in the quality of medical care provided to all Americans, most particularly those in need. Finally, rather than add some 30 million Americans to the ranks of the privately insured, Obamacare appears to be resulting in a net zero, as some 30 million Americans are predicted to be uninsured by 2022 as a result of the perverse effect of this costly new entitlement program.
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