Broken Promise #3: The Health Care Law Will Cover 32 Million Uninsured Americans

Mar 21, 2012

The President himself may not be doing anything this week to mark the two-year anniversary of his health care law, but his administration is working hard to convince the public that they really should like it.

To set the record straight here’s another post on one of the significant failings of the law. Today’s broken promise is:  The health care law will cover 32 million* uninsured Americans.

In February 2010, the White House released their health care reform plan with the promise of covering 32 million Americans. One way the law does that is by expanding Medicaid eligibility. Kaiser Health News reports:

Low-income adults, including those without children, will be eligible, as long as their incomes didn't exceed 133 percent of the federal poverty level, or $14,404 for individuals and $29,326 for a family of four, according to current poverty guidelines.

A Congressional Budget Office (CBO) report estimates that starting in 2016, “16 million to 17 million people will be enrolled in Medicaid and CHIP.”

However, just shoving more people into Medicaid doesn’t mean they’ll get coverage, because fewer and fewer doctors are accepting Medicaid patients. In 2010, the NY Times told the story of a Flint, MI woman who was enduring chemotherapy. Her doctor told her he would no longer treat her because he was no longer taking Medicaid patients. That's due to Medicaid's reimbursements being so low. Dr. Sahouri told the newspaper, “We’re really losing money on seeing those patients, not even breaking even. We were starting to lose more and more money, month after month.”

Dealing with Medicaid has been especially challenging for specialty physicians. reports on the situation of a Florida urologist:

Fort Myers Urologist Dr. Omar Benitez began taking Medicaid in some form or another since he started his practice in 1999. But over time, he found it harder and harder to convince himself why he should.

A few years ago, the other nineteen urologists in town stopped accepting the insurance. Their decision left Benitez and his partners carrying the extra load. Primary care physicians would refer all their Medicaid patients needing an urologist to his practice, because he was one of the few who would take them. The imbalance was difficult to handle.

At first he limited his practice to only two new Medicaid patients a day. But Benitez soon realized that even that wasn’t making much sense either.

“About two years ago, we made a decision that we would no longer accept Medicaid of any form,” he said. “We simply could not justify that any longer.”

Along with not being able to cover their costs--support staff, office space, and liability insurance, ect.--doctors find the Medicaid bureaucracy maddening. Dr. Benitez told

To collect a Medicaid fee, I now have to pay my billing person who’s going to spend time submitting requests – which often times get red-stamped and sent back saying they want additional documentation. So it may take two or three man-hours to try and get those funds.

The result of Medicaid's low reimbursement rates and bureaucratic hassle means Medicaid patients have trouble finding doctors. In a report on the two-year anniversary of the health care law, the Senate’s two doctors, Tom Coburn (R-OK) and John Barrasso (R-WY) note that “approximately 40 percent of physicians do not even accept Medicaid patients.” A 2011 Government Accountability Office report found that doctors taking part in the Medicaid and Children’s Health Insurance Program (CHIP) turn away a higher percentage of new Medicaid and CHIP children patients than those with private insurance.

Imagine the stress on the Medicaid program and the physicians that accept it when 16 million more people get shoved into it. Making sure the uninsured get meaningful health care is important, but using Medicaid as a means to do so is doomed to failure.

And now for another musical interlude:

*The NY Times and Reuters reported that 31 million uninsured would be covered, but the proposal hosted on the White House website promises 32 million. This doesn’t change the substance of my argument.

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