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As the New Year kicked off, the Obama Administration toasted Obamacare’s great enrollment surge:

  • 2 million have selected a health plan through the federal health law’s health insurance exchanges.
  • 3 million young adults under age 26 have health coverage on their parents’ policies.
  • 4 million individuals have gained coverage through Medicaid expansion.

Yes, enrollment numbers continue to increase, but that is to be expected; at this point in time, they have nowhere to go but up.  And the additional 4 million Medicaid enrollments do not directly result from Obamacare.  This touted statistic is a major party foul.

Why?

Under Obamacare, states have a choice whether to expand their Medicaid programs to largely cover childless adults living on up to 138% FPL (an income of $15,856).  North Carolina, along with half the nation, said no to Medicaid expansion.  So, again, the 4 million additional Medicaid enrollments cannot be tied to the federal health law’s existence.  Rather, a large portion of this number represents the woodwork population — individuals who were already eligible for medical assistance before the law passed in 2010.   

For example, the Centers for Medicare and Medicaid Services (CMS) reports that for the calendar month of November 2013, an additional 48,000 North Carolinians are determined eligible for both Medicaid and CHIP, the state’s medical assistance program for children.  These new enrollees have nothing to do with the law’s mission of reducing the number of uninsured.

The chart below outlines North Carolina’s Medicaid eligibility levels, by population category:

Meanwhile, Sean Trende’s excellent analysis in Real Clear Politics states the following:

Therefore, in total, of the 3.9 million individuals newly covered by Medicaid in October or November, only 1.9 million are from states that expanded Medicaid.  

The next question is: How many of these 1.9 million are eligible directly because of Obamacare’s Medicaid expansion, and how many were just "normal" Medicaid enrollees?  

Click here to read the rest of Trende’s analysis to find out.    

Insurance vs. Access

The intent of Obamacare’s Medicaid expansion provision is to not only reduce the number of uninsured, but also to provide low-income citizens with access to health care in less expensive settings rather than jacking up uncompensated care costs from emergency room visits.  Expansion also seeks to have this population capitalize on preventative health measures, aiming to reduce public health expenditures in the long run. 

This argument continues to fail.  According to the highly publicized 2008 Oregon Health Insurance Experiment, it turns out that Medicaid does not significantly improve the health outcomes of patients.  In the study, thousands of low-income Oregonians were randomly assigned to either Medicaid or no health coverage.  Differences in health outcomes were then measured between these two populations.  

And as of the most recent analysis, a glaring statistic was released in Science magazine by the experiment researchers: 40 percent.  That’s how much emergency room visits increased among the tested population of Oregonians who were given access to Medicaid compared to the population of low-income uninsured.  Furthermore, of this 40% increase in visits, 18% could have been treated in a primary care setting while 12% did not fall under emergency issue care. 

This data generates another solid argument as to why North Carolina should not expand Medicaid.  Just because patients are enrolled in Medicaid does not mean they have adequate access to health care.  More medical providers in the state are not accepting new Medicaid patients.  The gap between providing health insurance and receiving health care continues to widen. 

Click here for the Health Update archive.

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