‘Medicaid currently covers 53 million people at an overall cost of $373.9 billion (states are responsible for about half). But starting in 2014, ObamaCare rules will add about 20 million more, according to Richard Foster, the program’s chief actuary.’
Medicaid is already having some problems, is a political third-rail, and the gap between Obamacare and Medicaid state budgets might not be able to be closed at the moment. From his wife, Megan McArdle’s piece, a quote from the comments section:
“My sister is a physician and her clinical position is funded by the University (and a private foundation) where she is a Assistant Professor — she teaches one day each week and sees patients as general practitioner four days each week. Due to the unique financial status, her clinic doesn’t have the same profit/loss concerns that other physicians face but clinical revenues are still a concern for her department’s budget. She says virtually every Medicaid patient costs more to see than the reimbursements provide. Furthermore, because of their public service mandate, their clinic is one of only a handful of doctor offices in the area that accepts new Medicaid patients — which means that their new patients are disproportionately more likely to be Medicaid patients. The more Medicaid patients they see, the more unstable their budget gets. If you lower reimbursement rates then fewer physicians will accept Medicaid patients, leaving this clinic with an even greater proportion of Medicaid patients.“
Paul Ryan from a previous post tried to discuss the ‘doc fix:’
Atul Gawande At The New Yorker: ‘Testing, Testing’…From The New Yorker: Atul Gawande On Health Care-”The Cost Conundrum”