More than one in five Americans, or 68 million people, will receive their health coverage through Medicaid this year — more than any other government health program. But as it adds millions of beneficiaries as a result of President Obama’s healthcare law, there is mounting evidence that Medicaid is broken.
Medicaid is administered jointly by the state and federal government, offering health coverage to Americans earning up to about $16,000 in the states participating in Obamacare’s expansion of the program and up to roughly $12,000 in the states that do not.
Providing these benefits comes at a great cost to taxpayers. In fiscal 2013 (even before the program expanded) federal and state governments spent nearly $460 billion combined on Medicaid. Nearly a quarter of money spent by states went to finance the program in 2013, putting it ahead of elementary and secondary education as the biggest component of state budgets, according to the National Association of State Budget Officers.
But all this money being spent to extend coverage to low-income Americans hasn’t necessarily translated to access to healthcare. Because Medicaid doesn’t pay much to compensate doctors, it’s hard to convince doctors to join the program. And even if a doctor is listed as participating in Medicaid, it doesn’t mean beneficiaries can actually get a timely appointment, if they can get one at all.
A Dec. 8 report by the inspector general for the Department of Health and Human Services revealed that despite all the money being spent on Medicaid, it is difficult for beneficiaries to see doctors through the program. Investigators made calls to a random sample of 1,800 Medicaid primary care providers.
“We found that slightly more than half of providers could not offer appointments to enrollees,” the report said. “Notably, 35 percent could not be found at the location listed by the plan, and another 8 percent were at the location but said that they were not participating in the plan. An additional 8 percent were not accepting new patients. Among the providers who offered appointments, the median wait time was 2 weeks. However, over a quarter had wait times of more than 1 month, and 10 percent had wait times longer than 2 months.”
The problem may even be worse than that. The study was done in 2013, before the massive expansion of Medicaid that occurred in 2014 as a result of Obamacare. Another 9.1 million people were added to the Medicaid rolls through September of this year, according to DHS. (Experts at the Kaiser Family Foundation said it was difficult to say exactly how many of those beneficiaries had been added as a result of the law, because a certain number would have qualified anyway under previous eligibility rules.) The new beneficiaries put a further strain on a system already facing doctor shortages.
Furthermore, in 2013 and 2014, Obamacare provided a short-term boost in payments to doctors, but those are on track to expire at the end of the year, meaning fewer doctors will be motivated to accept new Medicaid patients.
A study from Oregon released by the New England Journal of Medicine last year found that gaining coverage through Medicaid did not translate into significant gains in measurable health outcomes.
The mounting failures of Medicaid are all the more reason for states that have not already expanded the program through Obamacare to avoid doing so. Beyond that, solving the broader problems with the program will require a new approach that injects more choice and competition into Medicaid, and provides more flexibility to states over how to implement the program in a way that best serves their own residents.
