ObamaCare Is Mostly about Expanding the Most Dysfunctional Part of the Health Care System

Edmund Haislmaier and Drew Gonshorowski:

While most of the attention has focused on the new health insurance
exchanges, the data indicate that a significant share of exchange
enrollments were likely the result of a substitution effect—meaning that
most of those who enrolled in new coverage through the exchanges during
the open enrollment period already had coverage through an
individual-market or employer-group plan. Given that increased
enrollment in Medicaid accounted for 71 percent of the net growth in
health insurance coverage during the first half of 2014, the inescapable
conclusion is that, at least when it comes to covering the uninsured,
Obamacare so far is mainly a simple expansion of Medicaid. [“Obamacare’s Enrollment Increase: Mainly Due to Medicaid Expansion,” by Edmund F. Haislmaier and Drew Gonshorowski, The Heritage Foundation, October 22]

And this would be a good time to remember that coverage does not
equal care, especially if you are in Medicaid. Kevin Dayaratna did an
extensive literature review a couple years ago, finding:

Academic literature has consistently illustrated that Medicaid
patients—adults and children—have inferior access to health care, and
notably poorer health outcomes, than privately insured patients. Due to
the program’s low reimbursement rates, more and more doctors are
refusing to even accept Medicaid. As a result, it is becoming
increasingly difficult for Medicaid patients to find access to primary
and specialty care physicians. [“Studies Show: Medicaid Patients Have Worse Access and Outcomes than the Privately Insured,” by Kevin Dayaratna, The Heritage Foundation, November 7, 2012]