The Oklahoman Editorial
The furor over the failure of federal exchanges, designed to funnel people to private insurance policies, has overshadowed the fact that Obamacare largely depends upon state Medicaid programs to absorb much of the uninsured population. Now Obamacare's flaws — not Republican opposition — are partially impeding that effort.
Nowhere is this more apparent than in Wisconsin, where lawmakers planned to shift roughly 72,000 people from Medicaid to the federal health insurance exchanges by Jan. 1. The individuals shifted would have been those with incomes between 100 percent and 200 percent of the federal poverty level. As those people were moved to private insurance, Wisconsin officials planned to simultaneously expand Medicaid eligibility so 83,000 childless adults with household incomes below 100 percent of the federal poverty level could be added to the program.
Needless to say, the actual rollout of Obamacare has decimated that plan. Only 877 Wisconsin residents were able to sign up for coverage through the federal exchange in October. As a result, Wisconsin lawmakers are now expected to reconvene in a special session to delay the plan by at least three months.
“The federal government failed to get its website fully operational, and it is irresponsible to force some Wisconsinites to pay the price for the federal government's failure,” Wisconsin Gov. Scott Walker, a Republican, said in a statement announcing the session.
Wisconsin, like Oklahoma, rejected Obamacare's Medicaid expansion. Walker's plan was touted as an alternative that would increase the number of people with insurance coverage without breaking the state government bank. Now Walker's plan is collapsing for the same reason Obamacare is failing: an unfounded faith in the basic competence of federal officials.
Oklahoma officials viewing Wisconsin's troubles may reasonably conclude their best course of action is to simply continue rejecting Medicaid expansion without attempting alternatives.
At the same time, doctors participating in Oklahoma's Medicaid plan — and all other states' Medicaid plans — face another problem. Merrill Matthews, a resident scholar with the Institute for Policy Innovation in Texas, noted at Forbes.com that doctors who accept Medicaid patients could face a 24 percent cut in reimbursements beginning Jan. 1 — all thanks to Obamacare.
Since 1997, federal law has mandated cuts in provider payments to doctors taking Medicare patients unless that program's spending came under control. It hasn't. Instead of enforcing the law and outraging elderly voters, Congress has routinely passed a “doc fix” postponing the provider cuts.
But when Obamacare passed Congress, Matthews notes the law included a provision requiring all state Medicaid programs to pay doctors the same rate as Medicare for 2013 and 2014. Hence, if the Medicare “doc fix” is not approved, it would lower both Medicare and Medicaid payments.
Medicaid and Medicare already typically pay doctors less than private insurance, sometimes much less. Absorbing significant new payment reductions from both programs could be devastating for countless providers. Many Oklahoma hospitals already blame their financial woes on an overdependence on low-paying Medicaid and Medicare.
In the end, Congress will probably pass another “doc fix,” but the financial uncertainty created could cause many doctors to be even more reluctant to accept new Medicare or Medicaid patients.
Thus, Obamacare's failed implementation and obvious structural flaws are not only undermining President Obama's namesake law, but also undermining other, long-standing federal health care programs and even related state efforts to increase health care coverage.