The other night while I was unthawing my toes (Alaska, yo?), we watched an analysis on PBS News that basically made the very one-sided case that replacing Obamacare would lead to dogs mating with cats because almost all the people who enrolled in Medicaid due to the law would lose their health insurance.
Is that true? I had to go look it up. The worry is understandable, but it turns out to be mostly unjustified. Yeah, some people would lose their insurance coverage under Medicaid. Most would not, according to Jonathan Gruber, one of the architects to Obamacare.
“Premium Subsidies, the Mandate, and Medicaid Expansion,” NBER Working Paper No. 22213,” is an April 2016 NBER study Gruber coauthored with Harvard’s Molly Frean and Benjamin D. Sommers. In it the authors showed Medicaid accounted for 60% of the increase in coverage due to Obamacare. Yeah, so much for that whole “paying your own way” message. These people are now on the welfare rolls and we’re all paying for their health care.
However, the authors also showed that 2/3 of that 60% were people already eligible for Medicaid before Obamacare began. These are people who won’t lose their coverage if Obamacare is repealed in its entirety.
Why was the number of people who were previously eligible but uncovered so high? If they were eligible, why weren’t they already receiving Medicaid? The authors don’t claim to know, but there are a few possible explanations.
It’s possible, maybe even probable, that these people didn’t know they were eligible for Medicaid until they were forced to sign up for Obamacare and then discovered they were eligible. For example, because it covers people up to 400% over the poverty level, families of four making $53,000 are eligible for Medicaid. I’m eligible for Medicaid, actually, and if I didn’t have employer-supported health insurance, an Obamacare Exchange worker would assign me to Medicaid … whether I like it or not.
Conversely, these eligible-but-previously-unenrolled-folks may have known they were eligible, but they didn’t bother with signing up for personal reasons that are as varied as the individuals under consideration. Among these reasons is the mandate effect. They knew they were eligible, but they didn’t want to enroll and only did so when it was required.
Believe it or not, there are still a lot of people who regard Medicaid as welfare and don’t want anything to do with welfare. To these Obamacare recipients, the program’s end will be a blessing. It will end the humiliation of being welfare recipients.
Most people newly covered by Medicaid expansion would remain eligible, but would now be free to choose whether to be covered or not. I know this shocks people who are convinced health insurance is something everyone needs, but there are many people who do not want it and would choose not to be covered simply because they don’t want to be.
Not having insurance does not mean you don’t have access to medical care. Before Obamacare, I knew lots of people who covered that deficiency with a catastrophic insurance plan and a savings account. Now, they’re broke paying premiums for health insurance they didn’t need or want and that they can’t afford to use because the premiums have eaten their savings. They actually have reduced medical care, even now that they have insurance.
By the way, Medicaid is HORRIBLE medical coverage. If you like waiting lists, limited medications, and having your personal life scrutinized by social workers … it’s a lovely system, but if you want actually medical care … not so much.
How do I know this? For 15 years, I was an administrator for a non-profit social work agency that was a Medicaid-recipient agency. I speak of what I know. No one who actually cares about their health should want to be in that system.