In the past few years I’ve scoffed at those who predicted that a failure of the ACA would somehow lead to single payer. After all, wishing won’t make it 60. But as I’ve watched the private-based exchanges fail so miserably, while Medicaid has quietly done gangbusters comparatively, I wonder:
Some states are signing up tens of thousands of new Medicaid enrollees in the initial weeks of the health law’s rollout, while placing far fewer in private health insurance—a divergence that suggests Medicaid expansion may be a larger part of the law than expected.
In one sense, the Medicaid figures are good news for the Affordable Care Act’s advocates, who hoped the law would reduce the number of Americans without health insurance.
But the predominance of Medicaid enrollees so far could also fuel criticism that the law will lead to a greater government grip on the health-care system, instead of leaving room for private health insurers to grow.
Well, if any conservatives worry about that last statement, they would want to get those exchanges working, no? Instead, I see people rooting for their failure.
The numbers are hard to deny:
In Washington state, one of the states that operates its own exchange, 87% of the 35,528 people who had enrolled in new insurance plans from Oct. 1 to Oct. 21 were joining Medicaid plans, according to state figures. By Thursday, 21,342 Kentuckians had newly enrolled in Medicaid, or 82% of total enrollees. In New York, about 64% of the 37,030 people who have finished enrolling were in Medicaid.
Some states like Maryland, Washington and California are using aggressive outreach to get people into Medicaid, including contacting those who are already on other programs such as food stamps, said Matt Salo, executive director of the National Association of Medicaid Directors.
“When you actively go out and aggressively target people, they sign up,” he said.
Navigators would help people similarly get into the private-insurance exchanges. Opponents of the ACA have tried to all but eliminate them, though.
Getting Medicaid is often simpler than private coverage, especially since many states have cut back on paperwork. Medicaid enrollees can go to state offices to sign up and avoid the federal HealthCare.gov portal, which currently can’t transfer information about Medicaid-eligible people to the states. And Medicaid enrollees typically have fewer decisions to make on deductibles, prescription-drug plans and doctor networks.
“There are no comparisons between those processes,” said Kip Piper, a Washington-based Medicare and Medicaid industry consultant. “It’s not like comparing apples to apples or even apples to oranges. It’s apples to poodles.”
For years, single-payer advocates have argued that Medicare-for-all would be simpler than the ACA. I’m hearing that sentiment from more and more people recently.
