Medicaid’s Problems And Obamacare

Stanley Feld M.D.,FACP. MACE

Some of my reader’s read my article about Moises and Medicaid on December 30, 2007. This was before President Obama was elected President.

At that time I was unsuccessful in my attempt to help Moises receive Medicaid healthcare coverage for his family of 4 in the state of Texas. I was successful in getting his kids covered in SCHIP.


We have all experienced the frustrations of government bureaucracy. The actual government policy might be praiseworthy. The execution of the policy hardly ever reflects the purpose of the policy.

Moises and Medicaid is an example of a failure to implement a policy designed to help the poor circa 2007. The consequences of not getting Medicaid coverage were potentially grave to Moises and his family. It is no different in 2013.

Moises is a hard working law abiding American citizen born in El Salvador. He is presently going through a government certified navigator to optain Medicaid coverage or Obamacare coverage..

He application is stuck. He does not know what his final income will be in 2013. I told him I thought they meant his income on his April 2013 tax return.

He started this application two weeks ago. It will not be completed by the December 23th deadline for January 1 coverage.

The Obama administration’s policy is to provide healthcare coverage for all.  

The poverty level income number is outdated. It was written in 1955. The income levels are supposed to be defined by the states. There have been slight increases in income levels to qualify for assistance each year. Medicaid eligibility is based on the poverty level in each state.

The federal government defines Medicaid eligibility in 2013 as earning an income of 133% above the poverty level. The poverty level is $23,550 for a family of four. One hundred and thirty three percent of that is $31,321.50 per year or approximately $15 per hour in a forty-hour work week.

"For many eligibility groups, income is calculated in relation to a percentage of the Federal Poverty Level (FPL). For example, 100% of the FPL for a family of four is $23,550 in 2013. The Federal Poverty Level is updated annually."

In 2007 President Bush did not permit a realistic change in the definition of poverty. The title of the New York Times article was “U.S. Curtailing Bids to Expand Medicaid Rolls.”

An hourly rate of $8.75 equates to a weekly pay of $350, monthly pay of $1,517, and an annual salary of $18,200. An hourly rate of $15.00 equates to a weekly pay of $600, monthly pay of $2,600, and an annual salary of $31,200.

 “On Dec. 20,2007 the Bush administration rejected a proposal by Ohio to expand its Medicaid program to cover 35,000 more children. Ohio now offers Medicaid to children with family incomes up to twice the poverty level, or about $41,000 a year for a family of four. The state had proposed increasing the limit to three times the poverty level, to about $62,000.”

Is it better not to work?  

The average national unemployment insurance benefit was about $300 per week in 2010, 2011, and 2012.  However, individual benefit levels vary greatly depending on the state and the worker’s previous earnings.  In addition, in several states, workers receive higher benefits if they have dependents. 

 The maximum state-provided benefit in 2012 ranged from $133 in Puerto Rico and $235 in Mississippi (the lowest for a state) to $653 ($979 with dependents) in Massachusetts.[11]  

A hard working laborer is probably better off on unemployment insurance than working especially if unemployment insurance is extended to 99 weeks.

The average national unemployment insurance benefit is equal to a little under $15 an hour.

Unemployment coverage is 99 weeks. These people are also eligible for Medicaid. If you earn one dollar over $15 an hour you are not eligible for Medicaid.

Do these numbers encourage people to work and be independent or dependent on government largess?

This is a disincentive for someone to be a productive worker and advance in an earning position.

Obamacare creates a disincentive to be independent and make more than $31,321.50 annually.

 The healthcare insurance subsidy is not readily available.  

Obamacare subsidies might be a good deal for the poor who work hard to increase their income. So far it looks like the premiums and the $5,000 dollar deductibles are unaffordable for working families.

The key to successful healthcare reform is to encourage consumers to take responsibility for their care through incentives. Healthcare reform must encourage independence, self-responsibility and not to be dependent on the government.

Medicaid has big problems.

Medicaid does not insure all eligible consumers.

Physician reimbursement is horrible.

Most physicians do not participate in Medicaid.

Why don’t eligible patients participate?

The Medicaid application is too complicated.

Many of these citizens are laborers with meager education and cannot understand the application.

Many come from countries where medical care is free. They feel intimidated by the lengthy application.

They are afraid of government questions because they have experienced government oppression in the past. They want to be independent of government.

They believe it is too difficult to see a doctor. They only go to doctors when they absolutely need to go to the doctor.

Obamacare does not deal with any of these issues.

 I became aware of another horrible truth about Medicaid this week.

 "MEDICAID COMMUNICATION NO. 10-08", PDF  on November 24, 2010 from the state of New Jersey updated guidelines that were issued in Medicaid Communication No. 00-16, dated August 10, 2000, governing the recovery of correctly paid Medicaid benefits from the estates of deceased Medicaid clients or former Medicaid clients.

 “Medicaid benefits received on or after age 55 are subject to estate recovery.

This is specifically stated and acknowledged on the authorization page of the

PA-1G Medicaid Application Form.”

“Estate recovery in New Jersey includes payments for ALL services, not merely

services for institutionalized clients. There is no limitation on the type of

service for which DMAHS can recover its payments from estates including managed care (HMO) capitation fees.”

Many other states are looking into enforcing the Medicaid mandate now that many sick older (greater than 55 years old) consumers are applying for Medicaid.

I believe in helping the less fortunate. I am not for increasing government waste and bureaucracy. I am not for the state taking away assets of the unfortunate family just because these consumers used Medicaid.

Who should you trust? Is it the government or yourself? The government’s job should be to level playing field for all the stakeholders. It is not to control the consumers and make them dependent on the government.

There are many things wrong with the Medicaid system. Rather than adding on to the complexity of the system and making it more inefficient, the Medicaid system must be revamped to encourage freedoms, independence, self responsibility, and incentives so that consumers can learn to become healthy, maintain their health and ultimately decrease the cost of healthcare.

A healthcare system that drives consumers into dependence on the state will diminish freedom, self-responsibility and incentives to stay healthy and diminish healthcare costs.  

It will ultimately fail.

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

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