A couple of numbers have gotten a lot of press coverage in the past couple of days …
The 2014 target enrollment for the Exchanges … 7 million.
The number of cancelled individual policies … 5 million.
The latter (5 million) is referred to by administration spokespeople as a “small sliver”.
The former (7 million) is generally positioned as a big, potentially unreachable number.
Gee, are 5 million and 7 million really that different?
Got me thinking and drove me to the official CBO estimates to do some digging re: ObamaCare numbers.
A couple of interesting points from the chart …
First, less than 1/3 of the uninsured become insured … 14 million on a base of 57 million.
A footnote to the reports says that the 57 million “… includes unauthorized immigrants.”
Now, 14 million is a lot, but all of this angst & disruption to only fix 1/3 of the problem?
Note also that the bulk of the newly insureds – 9 million out of 14 million — come thru an expansion of Medicaid and CHIP(Children’s Health Insurance Program).
Medicaid is a comprehensive, state-run, government-paid medical program for the poor … funded by general tax revenues.
Coverage is determined by household income (assuming no or negligible net worth).
ObamaCare extends Medicaid coverage by increasing the qualification cap to 133% of the defined poverty level income … which is currently $11,490 plus $4,020 for each additional person in the household.
The Supreme Court ruled that states can elect to extend the program per ObamaCare or not. The Feds are supposed to pay 100% of the extension costs for the first couple of years, and then 90% after that … but some people fear that subsequent administrations will bail, leaving the states holding more of the bag.
All members of a qualifying household get Medicaid benefits … which have no deductibles and no co-pays.
It’s hard to find anybody opposed to healthcare for the poor.
In the past, most doctors took on Medicaid patients as a public service … and some took Medicaid to increase capacity utilization (think, marginal costing – like an airline filling an empty seat).
But, an increasing number of doctors are demotivated to serve Medicaid patients since the reimbursement rates are far less than doctors’ costs-to-serve … and, according to several doctors I’ve spoken to, Medicaid patients account for a disproportionate number of appointment “no shows” causing havoc with scheduling.
So, many doctors have stopped accepting new Medicaid patients … as a first step to not managing out of Medicaid entirely.
That dynamic will cause a major problem for the ObamaCare scheme … especially given the below full cost reimbursements.
The demand is going up by 25% based on the number of people covered.
The supply of doctors is going down as some stop serving Medicaid patients.
And, arguably, the quality of doctors may go down …. with only underutilized doctors serving Medicaid patients.
In the recent elections, a Virginia Democratic candidate for state office called for making it mandatory that doctors accept Medicaid patients. Source
Stay tuned for more on these ObamaCare numbers …