Stanley Feld M.D.,FACP, MACE

The mainstream media has been very quiet about Obamacare lately as the defects in its execution keep rolling along.

You may recall President Obama telling Senator John Kerry and Representative Barney Frank not to worry about including a Public Option in the bill. He told them they would not have to include the Public Option in the Affordable Care Act.

Barney Frank said we would never get a single party payer system unless we have a Public Option in the bill.

President Obama was right. He didn’t need a Public Option because the single party payer system was already embedded in the bill without anyone knowing it.

Medi-Cal is California’s name for its Medicaid program. California is one of the states that have expanded the Medicaid program under Obamacare.

Twenty states have not expanded their Medicaid program for fear of the federal government impinging on states rights while sticking their state with the bill.

The states also feared increases in their budget deficit. States are required to balance their budget. The result would be an increase in state taxes.

The increase in state taxes would render the state unattractive to companies and their business. Less company growth would mean an increase in unemployment and a decrease in state tax revenue. A decrease in tax revenue would result in a decrease in state services.

President Obama said, “Don’t worry.” He promised to fund Medicaid expansion fully for the first 3 years. Federal funding would decrease after the first three years to 50%. The funding percent has changed a few times since that promise. One could not know the present decrease unless one read the Federal Register daily.

Expanding Medicaid was a key part of the Affordable Care Act (Obamacare). It was also a hidden trap set by President Obama to slip the healthcare system into a single party payer system by default. That is why President Obama insisted we did not need a Public Option.

Obamacare required nearly all Americans, under penalty of law, to have insurance starting in 2014.

“Though a surprise, the high Medi-Cal enrollment is generally hailed as a success. California’s uninsured population has been cut in half since Obamacare, in large part because so many Californians signed up for Medi-Cal, which is free for beneficiaries.

Medi-Cal was opened to all low-income Californians starting two years ago, with the federal government paying for those new enrollments.”

In 2016 one third (1 in 3) or 12.7 million Californians are covered by Medi-Cal.

The total cost of the Medi-Cal explosion is $91 billion dollars, up from $54 billion dollars in 2012. California is responsible for $12 billion dollars. It will increase California’s budget deficit and may result in another tax increase.

The cost per insured is $7,165.35.

“The Medi-Cal program continues to grow at a very substantial rate, which is great. We are very happy that we’re able to provide healthcare to getting close to 13 million Californians,” said Mari Cantwell, chief deputy director at the state Department of Health Care Services, at a hearing in downtown L.A. this month. But, Cantwell added: “Obviously with that comes cost.”

The Medi-Cal is viewed by many state officials as being underfunded.

Medi-Cal patients are struggling to find doctors.

Many patients are receiving low quality of care by government standards.

A psychiatrist in Los Angeles told me that all the private practice internists in L.A. require an upfront concierge fee of at least $2,000 a year at the beginning of the year to be in their panel. If this is true, Internists in L.A. are insulating themselves against the low reimbursement of Medi-Cal. This concierge fee increases the California physician shortage.

The result has been that groups of activists have filed a federal civil rights complaint alleging that Latinos are being denied access to healthcare because the program does not pay doctors enough.

“The Affordable Care Act allowed states to open up Medicaid to anyone making less than 138% of the federal poverty level.”

Twenty states did not sign up for the expanded Medicaid because of the fear of federal takeover and the further impingement of state rights.

Pre-Obamacare, states were required to pay 43% of Medicaid’s cost and the federal government paid 57% of the costs. States ran the program and determined reimbursement.

As costs increased reimbursement was decreased and physician participation decreased because of the decreased reimbursement.

As a result of the 20 states resisting Medicaid expansion the federal government will pay 100% of the cost of new expansion enrollees and 93 percent off the cost of expanding Medicaid over the next nine (9) years instead of the next two (2) years.

The present rule looks like a great deal for the states. However with the federal government paying most of the Medicaid bill for the next nine (9) years the federal government will want to control Medicare.

Who needs a Public Option to get to a single party payer?

Who is going to stop the federal government from changing the eligibility for Medicaid to 200 or 400% of the poverty level?

Who is going to force doctors to participate in Medicaid if they want to practice medicine with a federal license?

Where is the government going to get the money without having skyrocketing increases in taxes?

Tax laws and lack of pro-growth tax reforms are inhibiting America’s economic growth.

America has been set up to have the future state of healthcare be a single party payer system. President Obama has done it in a clever way. He has had no regard for being fiscally responsible in the face of a 19 trillion dollar, and rising, debt.

Single party payer systems have failed in England and Canada.

Why should America create another failure?

Can Americans have a future state healthcare system that is not destined to fail?

Yes we can!

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.

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