Many of “the 47%” Mitt Romney says “believe the government has a responsibility to care for” will find that ObamaCare’s first and deepest impact will be on those who need health security the most – those who are poorer, sicker, and older.
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This may come as a surprise since Health Secretary Kathleen Sebelius claimed at the Democratic convention that “no matter who you are, what stage of life you're in, this law is a good thing.”
How can it be that ObamaCare will harm the most vulnerable? The law calls for spending $2.6 trillion over the next 10 years to provide health insurance to as many as 30 million more people. But the law is so contrary to our economy and culture that millions of people will find access to medical care will be harder than before the law passed.
The poor: The health overhaul law will make it more difficult for lower-income Americans enrolled in Medicaid to get care by overloading the program. The sickest of those on Medicaid today will have an even harder time finding a physician to see them.
Medicaid recipients have a paper promise a long and very comprehensive list of medical services. But because Medicaid pays doctors so little, patients find it hard to find a doctor – especially a specialist – who can afford to take additional patients. That forces too many patients into hospital emergency rooms where, if they wait long enough, they will eventually be seen. They know all too well that there is big difference between having “coverage” and actual access to “care.”
Instead of reforming Medicaid, the Obama administration is encouraging states to add as many as 16 million more people, crushing those already enrolled beneath a mountain of new enrollees and bringing total Medicaid enrollment to nearly 85 million in 2020.
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And a physician shortage is looming. The Physicians Foundation surveyed doctors and found that 60% said that the new law will force them to close or restrict certain categories of patients. Of those, 93% said they will stop seeing or restrict the number of Medicaid patients they see, and 87% will close or restrict their Medicare practice.
Seniors: More than 11 million seniors have selected the popular Medicare Advantage plans, and many are at risk of losing their coverage because of ObamaCare’s $156 billion in cuts to the program. Those attracted to these plans, which provide more comprehensive medical coverage, are disproportionately lower-income and minorities who do not have the resources for expensive Medigap insurance or access to supplemental retiree coverage from their previous jobs.
And all seniors will have a more difficult time finding a physician because of the $716 billion in cuts that the health law makes to Medicare. Medicare is being used as a piggybank to pay for a massive expansion of entitlement programs. And the Independent Payment Advisory Board will be ready to ration future care.
Seniors are rightly worried about this rationing of care and finding a doctor who will take Medicare patients. How good is a Medicare card if physicians’ offices are closed, sold to the nearest hospital, or bankrupt, as Medicare actuaries predict many will be if ObamaCare’s cuts take effect?
Further, the scores of new government agencies that will be directing the practice of medicine already are setting up perverse incentives for physicians to avoid the sickest patients who are likely to need more services and cost the most. But doctors will be penalized financially under the “Physician Value-Based Payment Modifier” if their practice costs exceed a government-set threshold.
Children: Parents and grandparents of children in 17 states can no longer access child-only policies after HHS rules destroyed the market for health insurers. Insurers have pulled out of these markets, saying they would face “adverse selection” because the HHS rule destroys the basis for shared insurance against risk. One of the provisions of the health law that the Obama administration touts most enthusiastically is the requirement that employers who offer dependent coverage allow employees to add their 26 year old “children” to their policies. It is highly ironic, then, this other rule is causing huge losses of coverage among children whose parents or guardians were buying health insurance policies for them on their own.
The list can, and does, go on:
- One-third of businesses say they may drop insurance, causing families with good coverage today to lose it. McKinsey and Co. estimates that as many as 80 million people could lose the coverage they have now and be forced to get other policies that conform with ObamaCare rules. The Obama administration’s own estimates say that 51 to 80% of those with coverage could be forced to switch plans to comply with the law's new mandates.
- Dependents who are on a bread-winner’s policy today could lose their coverage and not be eligible to get insurance through the new exchanges because of IRS rules interpreting whether care is “affordable” to workers.
- Lower-income workers are at risk of losing their jobs or at least their full-time employment. ObamaCare is forcing many employers, especially in the retail and hospitality industries, to restructure their businesses to avoid ObamaCare fines for not providing government-approved health insurance by shifting their workforces to part time. Many say they have no choice since the ObamaCare fines alone would consume their entire profit margins.
- And after all of the taxing and spending, 30 million more people will remain uninsured.
The evidence shows that the most vulnerable citizens will be harmed first in this massive expansion and restructuring of our health sector. Many of the 47% will find they will be worse off after ObamaCare offers its helping hand.
Grace-Marie Turner is president of the Galen Institute, a non-profit research organization specializing in market-based health reform. She is a co-author of Why ObamaCare Is Wrong for America (HarperCollins/Broadside Books, 2011).