“The Patient Protection and Affordable Care Act (PPACA) is designed to extend health-insurance coverage to tens of millions of uninsured Americans. Rarely is it mentioned, however, that Medicaid, the government-run health-insurance program for the poor, will provide more than half of that new coverage under the law. The PPACA assigns Medicaid this central role, despite long-standing concerns about Medicaid’s costs and the quality of its care.”
“This means that by 2020, Medicaid enrollment will reach 85 million, or approximately one in four Americans. This level of dependence distorts the original purpose of the government program, which was intended to serve as a safety net for only the most vulnerable. As a result of the expansion, the report shows, Medicaid spending between 2011 and 2020 will increase under Obamacare by $619 billion. The federal government will initially pay for most of the new spending, totaling $572 billion. But the expansion will increasingly strain state budgets as well, since the federal contribution decreases overtime. The Medicaid expansion will bring total state Medicaid spending to $2.3 trillion through 2020.”
“About 16 million people — half of the 32 million who are expected to get health coverage under the new health law — will be enrolled in Medicaid in January of 2014, with almost no changes to improve or modernize the cumbersome, complex, and wasteful program. This large Medicaid expansion could have catastrophic effects on those who provide society’s health care safety net.”
“Landrieu, critics believe, pledged her vote in exchange for gaining $200 million additional federal funds for Louisiana’s Medicaid program. Except that, due to a drafting error, the law ended up giving Louisiana $4.3 billion in extra Medicaid funds: more than twenty times the assigned amount. How this happened, and how Congress failed to fully fix it, is a microcosm of our new health law’s many flaws.”
“ObamaCare will repeat the mistake when it enrolls about 16 million new people in Medicaid. Many will be converting from private coverage that pays physicians more than Medicaid pays (even with the somewhat higher rates for two years). The net result: millions of patients will have less access to care than they had before the reform.”
“When the Supreme Court hears the state challenge to ObamaCare later this year, most of the attention will likely be on the challenge to the law’s individual mandate to purchase health insurance and its implications for the Constitution’s Commerce Clause. But in a somewhat unexpected move, the Supreme Court has decided to allow for a full hour of oral argument regarding another part of the case: the expansion of Medicaid, the joint federal-state health program for the poor and disabled, which is expected to account for half of the law’s health coverage expansion.”
“Under the health care overhaul, the federal government will start taxing itself and the states beginning in 2014. And that’s giving state Medicaid directors heartburn. A report released Tuesday by the actuarial firm Milliman Inc. said the tax will cost the Medicaid program between $36.5 billion and $41.9 billion over 10 years. At least $13 billion will be borne by states, and at least $23.5 billion by the federal government, based on the state-federal Medicaid matching formula.”
“That is, states must now accept a comprehensive reorganization of Medicaid or forfeit all federal Medicaid funding—even though the spending power is circumscribed to preserve a distinction between what is local and what is national. If Congress is allowed to attach conditions to spending that the states cannot refuse in order to achieve an objective it could not outright mandate, the local/national distinction that is so central to federalism will be erased.”
“Twenty-six states on Tuesday asked the Supreme Court to overturn the health care reform law’s mandatory state expansion of the Medicaid program, a sleeper issue in the health care reform lawsuit that could determine how much leverage the federal government has with the states on any issue.
The states, led by Florida, argue that the federal government can’t force them to expand the Medicaid program, which has operated as a partnership between the feds and the states, as part of the 2010 health reform law. They argue that the Medicaid expansion is possibly more coercive than the law’s individual mandate.”
Create new demonstration projects in Medicaid to pay bundled payments for episodes of care that include hospitalizations (effective January 1, 2012 through December 31, 2016); to make global capitated payments to safety net hospital systems (effective fiscal years 2010 through 2012); to allow pediatric medical providers organized as accountable care organizations to share in cost-savings (effective January 1, 2012 through December 31, 2016); and to provide Medicaid payments to institutions of mental disease for adult enrollees who require stabilization of an emergency condition (effective October 1, 2011 through December 31, 2015).