“My critics say that I’m ‘cynical’ because I say that Medicaid’s reimbursement rates are too low, and yet oppose spending more money that we don’t have. This is a false dichotomy. There are a lot of things we can do to make Medicaid more cost-efficient: starting with converting the program into block grants for the states, and letting states focus on fully funding care for the truly needy.”

“Under the Patient Protection and Affordable Care Act (PPACA), Medicaid enrollment is expected to grow by 16 million people by 2019, an increase of more than 25 percent. Given the unwillingness of many primary care physicians (PCPs) to treat new Medicaid patients, policy makers and others are concerned about adequate primary care capacity to meet the increased demand. States with the smallest number of PCPs per capita overall—generally in the South and Mountain West—potentially will see the largest percentage increases in Medicaid enrollment, according to a new national study by the Center for Studying Health System Change (HSC). In contrast, states with the largest number of PCPs per capita—primarily in the Northeast—will see more modest increases in Medicaid enrollment. Moreover, geographic differences in PCP acceptance of new Medicaid patients reflect differences in overall PCP supply, not geographic differences in PCPs’ willingness to treat Medicaid patients.”

“So why do Medicaid patients fare so badly? Payment to providers has been reduced to literally pennies on each dollar of customary charges because of sequential rounds of indiscriminate rate cuts, like those now being pursued in states like New York and Illinois. As a result, doctors often cap how many Medicaid patients they’ll see in their practices. Meanwhile, patients can’t get timely access to routine and specialized medical care… President Barack Obama’s health plan follows this logic. Half of those gaining health insurance under ObamaCare will get it through Medicaid.”

“At issue is a provision in the health-overhaul law enacted in 2010 that says states can’t limit Medicaid eligibility or else they’ll lose federal funding.
As a result, every one of the country’s 29 Republican governors has asked the federal government to waive the requirement, with New Jersey penciling a waiver into its budget. Some states with Democratic governors, including Washington, are also quietly pressing for the change.”

“To consider what the expansion of Medicaid under ObamaCare might do to the states, take a look at Massachusetts and Tennessee. In 2006, Massachusetts overhauled its entire health-care system, including a significant expansion of Medicaid. This expansion is costing the state far more than expected. Gov. Deval Patrick approved a record-setting $9.6 billion to cover its share of Medicaid costs last July. It wasn’t enough. He’s already gone back to the legislature twice, adding almost $600 million in additional funds.”

“This month, Jan Brewer of Arizona became the first governor to request what most of the states really need — a waiver from HHS freeing the states from an Obamacare provision known as the maintenance of effort requirements. This is a mandate that forces states to maintain their current Medicaid rolls until 2014 for adults and 2019 for children. If the states trim programs, they end up forfeiting all of Medicaid’s federal matching funds.”

“Beginning in 2014, the Patient Protection and Affordable Care Act, signed into law in March 2010, is expected to significantly extend health-insurance coverage in New York by increasing Medicaid enrollment and offering federal subsidies for the purchase of private health insurance. However, there is no guarantee that the newly insured will be able to access the health-care system in a timely fashion as new demand for services outstrips physician supply.”

“One way to think about all this is to see the ACA as a sham of sorts. Long before the passage of the bill public opinion polls consistently showed over many years that the average voter was willing to pay only $100 or so to insure the uninsured. If you think about it, everything that has come out of the White House and other administration officials is consistent with that finding. ObamaCare, we are being told, is one big free lunch. No one’s premium will be higher. No one’s wage will be lower. Millions of people are supposed to benefit and no one is acknowledged to be the slightest bit worse off because of it.”

“GOP committee members repeated their warnings that the law will drive doctors away from treating older Americans, ruin people’s ability to keep their current health care, undermine the free enterprise system and place health care in the hands of what one called ‘unelected bureaucracies.’ These were arguments they and GOP House colleagues made last month when the chamber voted to repeal the entire law – a step the Senate has refused to take.”

“So, even though states can’t afford their current Medicaid obligations, ObamaCare forced an extension of existing eligibility standards until 2014. Arizona is especially affected because it has some of the most generous Medicaid eligibility standards in the country. Rather than allow states like Arizona to cut back to the level of other states, ObamaCare freezes in existing disparities. Beginning in June 2011, Arizona’s share of its Medicaid program will increase by $700 million. The annual cost of this mandate is almost $1 billion.”