Quote:I accept your objections to the ACA, and disagree with most of them.  They are very well stated, however, and consistent with your conservative philosophies.

 

I do have a decent pair of reading glasses, got them out, and read this again.  You made 2 statements here:

 

1) That these patients were pushed to a Medicaid instead of a commercial plan.  I'll take that at face value.

2) Medicaid care is of significantly lower quality.  When my mother reached retirement age, she qualified for Medicare, including part D.  She is satisfied with both.  She did not have to change providers.

 

What am I missing?

 

Thanks, it's cool to disagree without being disagreeable!

 

1. One of the hallmarks of the ACA is the enhancement of the state level Medicaid programs for the poor. The changes the ACA made increased the floor income requirements for enrolling in Medicaid meaning that more people qualify for the program, so instead of getting a commercial plan from an insurance company they go on the state dole. The ACA provides federal money to the states to help pay for these additional subscribers, but that subsidy begins to decrease after a few years. That was the topic of all the talk about Rick Scott and other governors refusing the federal money last year.

 

2. Medicaid is not Medicare. Since Medicaid is a state level program it is chronically underfunded. As a result, reimbursements in Medicaid are frequently 50% of the Medicare allowable or less. So Medicare (the federal program) has a large rate of participation among providers and a happy patient panel, but Medicaid (the state program) has significantly fewer doctors with corresponding dissatisfaction in the patients. This becomes more of a problem when all these new subscribers were added to the program. Here's the trick: the ACA has language that requires the states to increase the Medicaid reimbursement to the Medicare level to entice more physicians to participate, but as before, the subsidy to pay for all that additional outlay will only be here for a few years, then the states have to figure out a way to pay out twice the Medicaid dollars that they were before. It's a budgetary time bomb just waiting to explode around 2018.

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