California offers example of fallout from Obamacare

In a brief filed with the U.S. Court of Appeals for the Ninth Circuit, federal officials urged judges to uphold California's decision to cut Medicaid provider payments by 10 percent. California's providers argue that the rates are already too low. Dr. Paul R. Phinney, president of the California Medical Association, says two-thirds of California doctors can't afford to participate in Medicaid. He predicts the problem will get worse with new cuts.

On the other hand, the Obama administration's filing calls it “entirely appropriate” for states to consider provider cuts and argues routine rate reviews are necessary “to avoid the perpetuation of payment rates that are unnecessarily high.”

“There is no general mandate under Medicaid to reimburse providers for all or substantially all of their costs,” the administration's filing stated. Federal law requires Medicaid rates to be sufficient to provide health care access comparable to that enjoyed by the general population. However, “sufficient” is in the eye of the beholder, as California's medical community is learning.

Oklahoma's Medicaid provider payments have typically been better than those in some states, but that's partly due to Oklahoma's program enrollment being more restricted than other states. Inflating Medicaid rolls would likely create the same financial pressures seen elsewhere. The easiest path to cost reduction is for policymakers to slash doctor payments.

Given that Oklahoma already ranks 49th in primary health care physicians per 100,000 citizens, this could create a significant barrier to health care access.

Yet Obamacare backers continue to tout Medicaid expansion, arguing the outsized federal match provided states amounts to “free” money.