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The great Obamacare-Medicaid bait 'n' switch

Hey, are you one of the 9.7 million Americans who have been put onto the Medicaid rolls since 2013 mostly as a result of theAffordable Care Act?

Congratulations! But that and $2.75 will get you one ride on the New York City subway.


Doctor speaking to patient
Tetra Images | Brand X Pictures | Getty Images

That's because finding a doctor who accepts Medicaid payments – never all that easy to do even before 2013 – is getting harder than ever thanks to a steep drop in reimbursement rates for doctors who treat patients on Medicaid.

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When I say "steep," I mean it. We're talking an average of 43 percent nationwide and almost 60 percent in California. Incidentally, California has added 2.7 million more people to Medicaid since 2013.

The result is simple: more and more doctors are simply not accepting Medicaid patients and/or dropping the ones they already have.

And before you call those doctors greedy or evil, consider the alternative: Most private-practice doctors literally care for Medicaid patients at a personal financial loss. Do that too much and you start not being able to practice at all, and that will hurt everyone.

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By the way, did you know it was illegal for doctors to write off giving people care for free or at a financial loss on their taxes? Well it is. Meanwhile, lawyers and fancy law firms deduct tremendous amounts all the time for pro bono work. Remind me again, have there been more lawyers or doctors in Congress and the White House over the last 100 years?

The results will be particularly cruel to the millions of people who were always eligible for Medicaid, but only found out and did something about it because of all the ACA publicity over the last few years. Without an existing doctor relationship to work with, shopping for physicians who do accept new patients on Medicaid alone will be daunting to say the least.

So more and more Americans are "covered," but fewer and fewer Americans will actually be able to get health care. That's the Great Obamacare Bait 'n' Switch.

Now hold your horses, all you progressives clamoring for a "single payer" health-care system! I know you think this and all the other Obamacare failings are proof that single payer is the only answer.

But the truth is, this Medicaid debacle should be a stark warning to any of us who still think single payer can work.

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Because, my friends, when you consider the more than 130 million people currently "covered" by Medicaid and Medicare combined, the United States already is the largest single-payer health provider in the Western world.

How's that working for you?

And before you tell me how great Medicare is working relative to Medicaid and even private insurance, it's time for all of us to get real.

First off, more and more doctors are also starting to cut off Medicare patients and refusing to accept new ones. The reasons are the same as they are for Medicaid: The reimbursements are going down just as demand is getting higher.

Secondly, remember that Medicare has mostly worked decently since its inception in 1965 thanks to demographics. 50 years ago, the number of Americans old enough to be eligible for Medicare was tiny compared to our 65-and-older population now. Like Social Security, there was always a "Ponzi Scheme" aspect to the program. And please also remember that it was pushed into law by President Lyndon B. Johnson, a man who never took a breath without gauging how many votes or political donations it would get him. The idea that he advocated Medicare out of the kindness of his heart is naïve to say the least.

And so, 2015 is already turning out to be the year when Americans are going to learn the hard way that single-payer systems can only function via rationing. And with Medicaid enrollees, that rationing will especially be cruel because we're talking about millions of poor people who won't even get in the door to see a doctor in the first place. And that also means breaking the promise that emergency rooms will get some kind of traffic relief thanks to Obamacare. Those rejected Medicaid patients are going to have to go somewhere, and the ER will remain the only places that can't turn them away.

Not that some people aren't trying to change that. Newly-elected Virginia Delegate Kathleen Murphy has publicly called for a new state law forcing doctors to accept Medicaid and Medicare patients no matter what. As if the number of career physicians quitting the profession weren't bad enough, politicians like Murphy seem to be Hell-bent on pushing even more out the door whether they realize it or not.

All of this is all the more frustrating because none of it was ever really necessary. Instead of disrupting the entire private health-coverage system and requiring all employers to provide costly plans, several studies have shown that the cost of providing 100-percent care for all Americans with pre-existing conditions would have been $25 billion to $50 billion. And even if you throw in a whopping $200 billion to $250 billion more to help boost Medicaid reimbursements for decades to come, you still would be talking about a much cheaper financial and political cost than what we're seeing from the ACA.

The result is the U.S. government has actually found a way to be crueler to the poor, more unfair to doctors, and more costly for every taxpayer in America.

Way to go.

Commentary by Jake Novak, supervising producer of "Street Signs." Follow him on Twitter @jakejakeny.