Stanley Feld M.D.,FACP.MACE
When President Obama told Barry Frank and John Kerry “We don’t need a Public Option in the Affordable Care Act legislation” he was right.
Senator Chuck Grassley know all along what President Obama's scheme was. His problem was none of his Republican friend would listen to him or do anything about it.
President Obama’s goal all along was to sneak in a Public Option in through the expansion of Medicaid. He wanted the local states to be administratively and financially responsible for Medicaid while the Federal government controlled the system through regulations.
President Obama had figured out the way to get to a single party payer without a Public Option. However, he and his advisors misjudged the defects in Medicaid.
Republicans have been opposed to a single party payer system and government control of the healthcare system. Republicans felt government control would increase the cost of healthcare, increase inefficiency in the administration of healthcare care, ration healthcare and decrease access to healthcare.
President Obama thought he could use a myriad of regulations to help Obamacare back into a single party payer system. The State and Federal Health Exchanges (“so called Obamacare competitive model”) has resulted in both the health exchange and the private insurance industry increasing the cost of healthcare to unaffordable levels, decreasing access to care, rationing of care and destroying the healthcare system.
The politicians, in a state like California, by following the federal money, ignored the will of the people. The people hate Obamacare because it is restrictive. They are angry about the lie President Obama told them to get their support. “If you like your doctor you can keep your doctor. If you like your insurance you can keep your insurance.”
President Obama has created a healthcare system infrastructure that played on states’ greed. Many states have tremendously high budget deficits. They have over taxed state residents.
State citizens and businesses are leaving for more tax friendly states. The migration has created larger state budget deficits. State politicians say a way of getting more federal money into the states and perhaps attracting people back to the state will be by expanding Medicaid. The federal government promised to pay 100% for the first three years of the Medicaid expansion program
Twenty-two states fell into President Obama’s trap. These states are on their way to a single party payer system without even knowing it.
I predict his scheme will fail.
California was the first state to jump into this pot of boiling water.
The federal government is going to pay 100% of newly qualified enrollees to Medicaid until 2017. Medicaid is under state control.
A record number of people have signed up for Medi-Cal in California. This has led to huge cost increases in Medi-Cal. Its price tag has jumped from $59 billion to $91 billion.
Where does President Obama get the money to pay for it? He increased the federal deficit. I guess $32 billion dollars would be considered a rounding error to most Democrats in congress.
States will have to start paying 5% of the bill for the newly eligible and enrolled enrollees in 2017. In 2020 the states will start paying 10% of the bill.
Medi-Cal is the state's Medicaid plan for low-income Californians. Nearly one in three Californians now receive coverage in Medi-Cal. With its continued Medi-Cal expansion it is predicted to expand to 20 million by 2020.
The people of California are going to be the first victims of the increased costs and decreased services.
Every government program creates a complex bureaucracy along with money wasting inefficiencies and abuses.
California politicians were bragging about the great deal the government had given them.
"That's a really great deal for California," said Scott Graves, research director at the California Budget & Policy Center. "You don't find that anywhere else."
“UC researchers calculated that each new federal dollar brought to California by Medi-Cal will generate 5.4 cents in tax revenue for the state, which would mean several billion dollars. That's because the money creates jobs in healthcare, which creates income and sales tax.”
Over the years because of the cost overages, Medi-Cal has been forced to decrease reimbursement to physicians and ration both care and access to care. Physicians have opted out of Medi-Cal participation. As Medicaid has grown as a result of Obamacare, Medi-Cal patients cannot find a physician to care for them.
I suppose President Obama could force physicians to accept Medicaid payment in order to retain their license to practice medicine. This executive action would attack freedom of choice and propelling the United States further down the road to serfdom.
As predicted, a group of Californians filed a civil rights complaint against Medi-Cal, alleging that failures in the program have prevented Latinos from accessing their healthcare they needs.
“But the complaint filed with the U.S. Department of Health and Human Services claims that because Medi-Cal administrators don't pay doctors enough to see patients, they "effectively deny the full benefits of the Medi-Cal program to more than seven million Latino enrollees."
Many complain that Medi-Cal's reimbursement rates, among the lowest in the nation, create a shortage of doctors willing to see Medi-Cal patients.
“The audit confirmed our long-standing concerns about access for Medi-Cal patients,” said Anthony Wright, executive director of the advocacy group Health Access California. “The findings of the audit cry out for more oversight.”
Gov. Jerry Brown’s budget for the 2014-15 fiscal year accommodates an influx of uninsured residents into Medi-Cal.
“However, at Governor Brown’s request, the Legislature left in place a 10 percent recession-era cut in reimbursement to most doctors, dentists and other health care providers who treat Medi-Cal patients.”
Health providers predicted this harmful contradiction. The contradiction is that Medi-Cal expansion will provide more of the poor with adequate healthcare coverage. It is, in fact, reducing poor persons ability to get into clinics, practices and even hospitals.
The optimism of politicians for the expansion of Medi-Cal improve state revenue has vanished. California’s deficit is increasing rapidly as a result of Obamacare’s largess.
In California, state officials are discussing how they'll afford the program next year (2017). Gov. Jerry Brown called a special legislative session this year to address funding for Medi-Cal.
"It's a strained system," said Hernandez, "and I really believe we need to figure out how to resolve. "
The 20 states that have not accepted President Obama’s offer to expand Medicaid were correct. These states wanted to make their own decision in the name of states’ rights. Many of the states could not afford expansion in the way President Obama was dictating it. Their budget deficits and taxes would have to increase.
California has just proven these states fears. In 2017 California will start paying 5% into the Medi-Cal expansion. It will make the budget deficit worse.
California will, once again, start begging the federal government to bale it out.
President Obama’s plan was to dump the financial burden on the states while controlling the system and creating a single party payer by default.
There is a much better way to provide healthcare to all people at an affordable cost.
The better way is to put consumers in control of their healthcare dollars.
They will control their health to avoid costly complications of chronic diseases. The people will be given financial incentive to be responsible for their health to try to avoid the onset of chronic disease.
The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.
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