l****z 发帖数: 29846 | 1 January 15, 2015 - 11:45 AM
By Michael D. Tanner
Poll: 51% Still Oppose Obamacare and 19% Say It’s Hurting Their Family Now
No matter how badly you want something to be true, simply wishing will not
make it so. This is a lesson that Obamacare supporters need to learn, as
they tell us yet again that the Affordable Care Act “is working.”
The latest claims stem in part from evidence that the number of uninsured
Americans has been steadily declining. It is true that the most recent poll
from Gallup found that the uninsured rate fell to 12.9 percent in the fourth
quarter of 2014, down from 16.3 percent before the ACA passed.
Of course, it would be a mistake to attribute all of that improvement to the
ACA. A large portion may be due to falling unemployment as the economy
finally emerges from the recession. Since most Americans get their health
insurance through their jobs, lower unemployment should naturally reduce the
number of uninsured.
Still, the ACA can rightly be credited with some of the gains. If you
subsidize something, you should expect to get more of it. And Obamacare
heavily subsidizes health insurance.
The problem is, that statement uses the term “insurance” very loosely. In
actuality, roughly 60 percent of those newly “insured” through Obamacare
are actually being enrolled in Medicaid. And Medicaid is hardly the same as
real insurance.
While Medicaid costs taxpayers a lot of money, it pays doctors little. As a
result, many doctors limit the number of Medicaid patients they serve, or
refuse to take them at all.
An analysis published in Health Affairs found that only 69 percent of
physicians accept Medicaid patients. Another study, in the New England
Journal of Medicine, found that Medicaid recipients were six times more
likely to be denied an appointment than people with private insurance. And,
according to a third study, when they do get an appointment, they wait an
average of 42 days to see a doctor, twice as long as the privately insured.
Just last month HHS’s Office of Inspector General released a report showing
how difficult it was for Medicaid patients to gain access to care through
Medicaid managed-care programs. IG inspectors posed as Medicaid patients and
called designated Medicaid managed-care providers. More than half of listed
providers could not be found at the location listed. Others were found but
were not participating in the plan, while still others were no longer taking
new Medicaid patients. When the investigators were able to get appointments
, they faced lengthy average wait times. In 28 percent of cases, they had to
wait longer than a month to see a doctor. Ten percent of the time, the wait
exceeded two months. A 2012 report from the Government Accountability
Office (GAO) confirmed that Medicaid patients faced serious accessibility
problems.
And things are about to get even worse.
In an attempt to encourage more doctors to accept Medicaid, Obamacare
included a temporary two-year increase in the program’s reimbursement rates
. After costing taxpayers roughly $5.5 billion in 2013–14, that increase
expired on January 1. Some states are planning to tap their own taxpayers in
order to extend the increased reimbursement, but others are unlikely to
come up with the money to pay for the extension. In states that don’t pony
up their own money — covering an estimated 71 percent of Medicaid
recipients — physician reimbursements could fall by as much as 47 percent.
That’s not going to encourage doctors to sign up more Medicaid patients.
Yet, at the same time, the number of people on Medicaid will have increased
significantly. Counting normal Medicaid growth as well as the ACA, as many
as 20 million more Medicaid enrollees could be seeking care compared with
just five years ago.
It doesn’t require an economic genius to realize what happens when
increased demand meets reduced supply.
One of the myths of government-run health care has always been the idea that
saying people are “covered” is the same thing as giving them health care.
We see that in single-payer systems around the world, where universal
coverage actually means waiting lists or rationing.
If Obamacare advocates are going to insist that enrollment numbers mean that
the ACA is working, they are going to have to come up with a different
definition of “working.”
Michael Tanner is a senior fellow at the Cato Institute and the author of "
Leviathan on the Right: How Big-Government Conservatism Brought Down the
Republican Revolution." |
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