Here’s the good news. Only 1 percent of Americans (1) are legal US residents, (2) are uninsured and (3) do not have access to subsidized health insurance. This fact comes from a health economist brian blazebased on recent Congressional Budget Office Report,
Currently, 24.3 million individuals in the United States are uninsured. But apart from those who are here illegally, virtually everyone else is eligible to enroll in Medicaid, Medicare or Obamacare exchanges or private plans offered by employers.
Medicaid enrollment is free, Obamacare insurance is heavily subsidized and almost all employer-provided insurance is required to be “affordable.” So sure, we’ve achieved “universal coverage” or something very close to it.
Here’s the bad news. Almost all of the increase in health insurance coverage under Obamacare is the result of Medicaid expansion. When Obamacare was being debated, its advocates never said they planned to insure the uninsured with Medicaid. But That’s what happened.
what’s wrong with that? Two things.
First, because Medicaid pays the lowest provider fees, Medicaid enrollees are the last patients doctors want to see. about a third of doctors Will not take any new Medicaid patients at all. Second, since eligibility for Medicaid is determined by income, people find that they are Repeatedly nominated and canceled In the span of a few years.
Families at the bottom of the income ladder find that as their incomes go up and down and as their job opportunities go up and down, they lose eligibility for Medicaid, the subsidized insurance in the Obamacare exchanges. Eligibility bounces back and forth between employer-provided eligibility. Coverage and sometimes no eligibility for any of the above. No continuity of health insurance usually means no continuity of medical care.
Based on raw data, the Congressional Budget Office tells us the number of people with private insurance has increased 1.6 million In the last decade. But remember, Obamacare came into existence when America was recovering from the Great Recession. Therefore, even without any changes in health policy, we would expect that as more people get jobs, more people will be privately insured. Overall, there is no reason to think that Obamacare has increased the number of people with private coverage at all.
However, there has been a major change in the type of private insurance people have. The number of people with coverage purchased in the Obamacare exchanges (where the average government subsidy is about $6,000) has increased. offset From a reduction in employer-provided coverage (where the average subsidy is $2,170).
What’s wrong with this, other than unnecessarily increasing the federal deficit? Four more things.
First, typical plans offered in the exchanges pay provider rates that are not much higher than Medicaid pays. As a result, these plans resemble high-deductible Medicaid. Second, the deductions are really high. For example, in Dallas, Texas, an average-income family of four who gets insurance in the exchange pays no premiums at all. But if a family member gets sick, the out-of-pocket cost is $9,100. If two family members get sick the risk is $18,200. And this happens every year.
At lower levels of income, children may qualify for Medicaid and adults may qualify for subsidies that reduce their out-of-pocket costs. But these freebies provided by the government are far from “free”. As incomes rise, the benefits rapidly dissipate. So, if a family earns an extra $1,000 in wages, they may lose many times that amount due to higher health care costs.
The fourth problem is that people enrolled in Obamacare exchange plans often do not have access to the best doctors and best hospitals. For example, our Dallas family has no access to the city’s Baylor Medical Center or UT Southwestern Medical Center, or MD Anderson Cancer Center in Houston.
Consider these titles:
Infant mortality rate has increased for the first time in 20 years,
Nearly four in ten people enrolled in Medicaid delay care because of cost,
Traffic in emergency rooms is higher than ever, Average wait time is two and a half hours,
Patients have to wait 13 hours for free health care,
Despite the presence of universal coverage, we are doing a very poor job of providing care to those at the bottom of the income ladder. Careful study has shown that Medicaid itself is a poor health insurance plan. in most microscopic study Investigating this issue, researchers found that Medicaid in Oregon had no effect on the physical health of enrollees and that after enrollment, emergency room traffic actually increased. A later study found that people enrolled in Medicaid greatly underestimate their participation in Medicaid 20 cents on the dollar,
It’s not clear that Obamacare’s exchange insurance is that much better. One reason Congress added an additional level of subsidies for high-income households in recent years is that the non-subsidized portion of the individual market was in one. death circle, It seems that very few people are willing to pay market price for what Obamacare offers.
All that said, there are areas of excellence here and there within the safety net.
Parkland Hospital About 13,000 babies are born in Dallas each year. It is one of the largest child delivery centers in the country. Nearly all of the mothers are low-income minorities. More than three-quarters of the people are Hispanic, and I suspect many of those people are undocumented. This is a group researchers call “at risk.” Yet among those who undergo prenatal programs, the infant mortality rate is half that of similar populations elsewhere.
The Parkland Baby Delivery Program has been running for decades, and I’ve written about it priceless, It includes comprehensive prenatal and postnatal care provided by nurses. Most deliveries are conducted by midwives rather than obstetricians.
Although the hospital does not release statistics, I suspect that this non-profit is actually improving the health of infants by pooling together various sources of government funding, reducing personnel costs, and avoiding costly complications that lead to infant and maternal death. Earns “profit” on deliveries. ,
Parkland’s baby distribution program is an example of a Harvard professor Regina Herzlinger This is called a “concentrated factory”. These are places where providers are really good at providing high-quality, efficient care. If we changed the way the health care safety net operates there would be a lot of parkland around.
Boston University economist Lawrence Kotlikoff I has advocated replacing Medicaid, the Obamacare exchanges, and other safety net programs. A system that works like Medicare Advantage. Risk-adjusted payments will be made to competing organizations. Those who succeed in providing high-quality, efficient care will be rewarded financially. Those failing in this regard will be punished with financial losses.
A first step toward that goal would be for the health policy community to recognize that the achievement of nearly universal health insurance coverage has not created universal access to high-quality care.