The predominant purpose of ObamaCare was to achieve liberals’ long-sought goal of universal health care coverage in America. Although the law falls short of this goal with the CBO estimating 26 million will remain uninsured, it significantly closes the coverage gap through a dramatic expansion of the joint state-federal Medicaid program in 2014 to almost one quarter of the population. Not surprisingly, Republican Governors are kicking and screaming for relief.
With the recession fueling 5.2 million new Medicaid enrollees from 2008 to 2009 alone and growth in the program’s spending almost doubling from 4.8 to 9 percent in the same period, many states are already struggling to pay for this additional cost from the eligibility-based obligation. For example, Texas expects an additional Medicaid cost of $9.1 billion through 2013, an amount that if only paid for by cutting provider reimbursement rate cuts, would require them to be slashed by 48%, resulting in rates so low that virtually no provider will see patients.
Tragically, this is just one programmatic driver of state budget shortfalls that nationwide run around $130-140 billion per year. Now add on ObamaCare’s new unfunded Medicaid mandate on states that Kaiser estimates to total $21.2 billion over six years and you create some very unhappy Governors.
Twenty-nine of them to be exact. This is the number that sent a joint letter to the White House and congressional leaders asking them for more flexibility to set eligibility and spending levels.
Note to Republican Governors, don’t hold your breath for new flexibility from a statist Administration committed to centralized governance or you may easily find your state even deeper in the red. For substantive change you’re simply going to have to wait for a new President that’s committed to reform.
However, that doesn’t mean those seeking reform should just sit on their hands until this time. In the fight to reduce the size and scope of the federal government, the disaster that is Medicaid offers the GOP a powerful opportunity to display the all-too-real problems of government-run programs and advance the argument for greater deference to states and individuals.
On average the entitlement reimburses doctors 56 percent of private sector rates, leading 28 percent of doctors to refuse seeing any Medicaid patients, 19 percent accepting some, and only 40 percent are willing to treat all. These denials then force patients to resort to emergency rooms that drive the cost of care higher for us all.