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NINTH OBAMACARE CO-OP IMPLODES

A South Carolina health insurer has become the ninth insurance cooperative formed nationwide under the Affordable Care Act to fold. Consumers’ Choice Health Insurance Co. said Thursday that it will not sell policies in 2016, a decision that will leave 67,000 individuals and business customers looking for new coverage. Ray Farmer, director of the South Carolina Department of Insurance, said Consumers’ Choice and state regulators reached a mutual decision to shut down the company’s business. He said the company was in a “financially hazardous condition.”

It seems Mr. Farmer may have stumbled upon a solid new slogan for the entire law. The New York Times analyzes the “cascading failures” of Obamacare co-ops across the country:

The grim announcements keep coming, picking up pace in recent weeks. About a third, or eight, alternative health insurers created under President Obama’s health care law to spur competition that might have made coverage less expensive for consumers are shutting down. The three largest are among that number. Only 14 of the so-called cooperatives are still standing, some precariously. The toll of failed co-op insurers, which were intended to challenge dominant companies that wield considerable power to dictate prices, has left about 500,000 customers scrambling to find health insurance for next year…At a time when the industry is experiencing a wave of consolidation, with giants like Anthem and Aetna planning to buy their smaller rivals, the vanishing co-ops will leave some consumers with fewer choices — and potentially higher prices…The shuttering of these start-ups amounts to what could be a loss of nearly $1 billion in federal loans provided to help them get started. And the cascading series of failures has also led to skepticism about the Obama administration’s commitment to this venture. Some policy analysts say they were doomed from the beginning.

Obamacare Entering ‘Death Spiral’

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by Betsy McCaughey

ObamaCare is heading toward a death spiral.

The Obama administration is having trouble selling insurance plans to healthy people. That’s a big problem: When the young and healthy don’t enroll, premiums have to be hiked to cover the costs of older, sicker people, discouraging even more young people from signing up.

Last Thursday, the administration predicted enrollment for 2016 will be less than half what the Congressional Budget Office predicted in March.

Despite subsidies to help with premiums and out-of-pocket costs, most of the uninsured who are eligible for ObamaCare are saying “no thanks.” Only one in seven is expected to sign up. That’s despite a hefty increase in the financial penalty next year for not having insurance.

The president sees the writing on the wall. You won’t be seeing the customary nationwide TV campaign to encourage sign-ups, as there were in previous years. Remember the young guy in plaid pajamas — “Pajama Boy,” to conservatives — well, he won’t be back this winter.

Bad enough that healthy people aren’t buying. Worse is that the administration is spending billions of your tax dollars covering up the problem, paying insurers to keep offering the plans, even though they’re losing their shirts. But facts are facts — and there’s no hiding these.

Health and Human Services Secretary Sylvia Burwell predicts ObamaCare enrollment will inch up by 1 million or so, to 10 million people — half what the CBO forecasted. Open enrollment for the coming year, which begins Nov. 1, “is going to be a challenge,” she said.

David Wichmann, UnitedHealth Group’s president, announced higher premiums last week because enrollees will “require more medical services than original expectations.”

Many states (though not New York) are looking at premium hikes of 30 percent or more, according to a new Robert Wood Johnson/Urban Institute analysis. The Heritage Foundation estimates that insurers lost 12 percent selling ACA plans in 2014, with more losses this year.

Don’t shed any tears for the insurance companies. Though they’re losing money on exchange plans, overall they’re profitable and their stocks are doing well. It’s John Q. Public who’s bearing the brunt. Just as ObamaCare intended.

If you get insurance at work, you’re paying an extra tax to fund “reinsurance” for ObamaCare plans. It’s a fund to defray the cost of their most expensive enrollees.

So far, insurers have collected about $7.9 billion. Recent congressional testimony shows the payments kept ObamaCare sticker prices about 11 percent lower than they otherwise would have been. In short, you pay a tax to make ObamaCare look more affordable than it is.

But even with these hidden subsidies, ObamaCare isn’t working because the design is fatally flawed. The 5 percent of the population with serious medical conditions consume nearly 50 percent of the health care. When you try to sell insurance to sick and healthy people for the same price, the healthy don’t sign up. It’s too expensive.

New York state learned that in the 1990s, when one-price-for-all insurance laws pushed premiums to the highest in the nation, crushing the individual insurance market here.

ObamaCare repeats that mistake. Despite slapping the uninsured with penalties — which will jump to 2.5 percent of household income in 2016 — they’re not signing up. The need to coerce enrollment with penalties is proof the plans are a bad deal.

How long will big insurers play along? There are political considerations, and for most, ObamaCare losses are still just a dent in their overall business. Not so for the 23 co-op insurers set up under the health law. Eight state plans have already failed, including New York’s Health Republic, and most of the rest are bleeding money.

With ObamaCare enrollment floundering and losses mounting, the nation needs alternatives. The Republicans are coalescing around a reform plan, but Democrats are doubling down. Hillary Rodham Clinton wants to burden the existing, unpopular plans with more “free” goodies, and make it harder to dodge the mandate. That won’t work.

A real reform would cover the seriously ill — people with pre-existing conditions — in separate plans with separate pricing and subsidies to make them affordable.

Just like the high-risk pools many states used to maintain. That’s the lesson of the failing ObamaCare scheme.

Betsy McCaughey is the author of “Beating ObamaCare” and a senior fellow at the London Center for Policy Research.

Bombshell: Federal Judge Says Americans Can’t be Forced to Follow Obamacare Mandates!

Monday was a wonderful day in court for conservatives and pro-lifers across the nation. Federal judge Richard Leon handed down his ruling on Monday, permanently prohibiting the federal government from forcing its Obamacare abortion-pill mandate on any pro-life organization – regardless of its religious beliefs.

Up until this decision the Obama administration had argued that any organization that was not a church or religious organization could be forced to offer abortifacients and other contraceptives through their health care plans. However, Judge Richard Leon disagreed.

Judge Leon found that an organization’s moral objections (religious or otherwise) were enough to keep the government from forcing certain Obamacare provisions on them.

Read more at http://visiontoamerica.com/23679/bombshell-federal-judge-says-americans-cant-be-forced-to-follow-obamacare-mandates/#Y45TdgUrPDh8vKHR.99

Call the Medic

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Supreme Court Chief Justice John Roberts has rewritten the law to save Obamacare—again.

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Roberts’ majority opinion today in King v. Burwell, which ruled that the Obama administration’s decision to allow health insurance subsidies flow through the law’s federal exchanges, leaves no doubt that Roberts considers it his duty to keep the law afloat.

“Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them,” he writes. “If at all possible, we must interpret the Act in a way that is consistent with the former, and avoids the latter.”

And so Roberts decided that a law which explicitly and repeatedly states that subsidies are limited to exchanges “established by a State,” and which defines “State” as one of the 50 states or the District of Columbia, actually allows subsidies in exchanges established by a State or the federal government. Roberts’ decision does not interpret Obamacare; it adds to it and reworks it, and in the process transforms it into something that it is not.

Roberts has not merely tweaked the law; he has rewritten it to mean the opposite of what it clearly means. Why include the phrase “established by a State under Section 1311″—the section dealing with state-based exchanges—except to limit the subsidies to those particular exchanges? Roberts’ opinion reconceptualizes this limiting language as inclusive.

The Chief Justice frames his decision as a form of respectful deference to congressional intent. As my colleague Damon Root noted earlier, his opinion cautions that in “every case we must respect the role of the Legislature, and take care not to undo what it has done. A fair reading of legislation demands a fair understanding of the legislative plan.”

But Roberts’ opinion is far more than a fair reading of the legislative plan; it is a Court-imposed decision as to what that plan must be.

As Justice Antonin Scalia writes in a scathing dissent, Roberts presumes, with no definitive evidence, that his interpretation is the one that Congress intended. “What makes the Court so sure that Congress ‘meant’ tax credits to be available everywhere?” Scalia asks. “Our only evidence of what Congress meant comes from the terms of the law, and those terms show beyond all question that tax credits are available only on state Exchanges.”

Roberts’ opinion declares its intent to uphold the law’s basic policy scheme, arguing that there would be adverse insurance market effects to a decision in favor of the challengers. In other words, there would have been policy implications to a ruling for the plaintiffs. That is almost certainly true, but it is not an excuse to rewrite the clear language of the law.

As Scalia says in the dissent, “The Court protests that without the tax credits, the number of people covered by the individual mandate shrinks, and without a broadly applicable individual mandate the guaranteed-issue and community-rating requirements ‘would destabilize the individual insurance market.’ If true, these projections would show only that the statutory scheme contains a flaw; they would not show that the statute means the opposite of what it says.” The majority has decided how Obamacare’s policy scheme should work, and redrafted the statute accordingly.

If Roberts had truly wanted to defer to Congress, he could have ruled that the law means what says rather than what it does not, and effectively handed the issue back to the legislature, letting Congress decide whether and how to update the law in accordance with its own wishes. Instead, Roberts made the choice for Congress—taking its power to craft law for itself. As Scalia writes, “the Court’s insistence on making a choice that should be made by Congress both aggrandizes judicial power and encourages congressional lassitude.”

This is not the first time that Roberts has rewritten the law in order to uphold it. In 2012, he declared that the law’s individual mandate to purchase insurance was unconstitutional under the Constitution’s Commerce Clause—and yet upheld it by declaring that the law’s penalty was instead permissible as a tax. In the same decision, he also found that the law’s threat to revoke all federal Medicaid funding from states that decline to participate in Obamacare’s expansion of the program was unconstitutionally coercive. But rather than strike the whole thing down, Roberts rewrote it, allowing the Medicaid expansion, and the rest of the law, to continue but without the same threat to state budgets.

In his dissent, Scalia argues that there’s a pattern to these rulings. “Under all the usual rules of interpretation, in short, the Government should lose this case. But normal rules of interpretation seem always to yield to the overriding principle of the present Court: The Affordable Care Act must be saved.”

If anything, it’s even worse. What Roberts has saved is not the law so much as the Obama administration’s dubious, textually unsupported interpretation and implementation of Obamacare. This is not judicial restraint. It is judicial hubris.

And while it would be overstatement to say that this damages the legitimacy of the Court, it certainly reflects on the legacy and status of the law. As even Roberts admits in his opinion, the law “contains more than a few examples of inartful drafting” and generally “does not reflect the type of care and deliberation that one might expect of such significant legislation.” It is a shoddy, messy piece of legislation, held together, barely, by Supreme Court duct tape.

At this point, then, the law is as much a joint project between the administration and the Roberts court as it is a creation of Congress. As Scalia snarks at the end of his dissent, “we should start calling this law SCOTUScare.” Regardless of what we call it, that’s effectively what it has become.

ObamaCare Beyond the Handouts – Wall Street journal June 24th

We’ve already proved we can subsidize health care. But which subsidies make sense?
By HOLMAN W. JENKINS, JR.

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By one standard no government program can fail, and that’s the standard being applied to ObamaCare by its supporters: If a program exists and delivers benefits, the program is working.

Paul Krugman, Nancy Pelosi and others consistently point to the fact that people are willingly receiving ObamaCare benefits as proof of the program’s value. Mr. Obama himself says: “When you talk to people who actually are enrolled in a new marketplace plan, the vast majority of them like their coverage. The vast majority are satisfied.”

And the polls indeed show that 74% of ObamaCare’s eight million enrollees are “satisfied” with their plans, because the polls fail to count the 12 million who are eligible but decline to enroll.

Of the eight million who have signed up, some 87% are receiving taxpayer subsidies. In other words, they are getting health care partly or wholly at someone else’s expense. The latest data reveal that the average monthly benefit amounts to $276 per person (up from $268 in February), allowing the typical HealthCare.gov user to buy a plan for $69 per month out of pocket.

To put it another way, the annual subsidy amounts to $3,312 per recipient. Which is excellent if you’re one of the recipients.

Steve Rattner, a Wall Street figure and President Obama’s former auto-bailout czar, insists in a recent New York Times op-ed that ObamaCare “is working,” by which he apparently means it’s in operation, which nobody denies. Mr. Rattner, like a lot of analysts, writes as if costs are benefits—as if millions of people lining up for something from the wallets of their fellow citizens, ipso facto, is proof of a worthwhile program.

Mr. Rattner, in a throwaway line—really, a partisan pleasantry—adds without evidence or elaboration that health-care costs are lower than they otherwise would be at least partly due to the new law.

Now, if this were true, it would be the greatest validation of ObamaCare as public policy but there is no reason to believe it’s true.

The right question about any program is whether the benefits justify the expenditure of taxpayer money. ObamaCare’s cheerleaders provide not cost-benefit analysis but benefit analysis—as if money grows on trees or is donated by Martians or can be printed in limitless quantities by the Fed.

ObamaCare, with its subsidies to those with low incomes, is not the worst thing in our health-care system by far. Medicare indiscriminately subsidizes everyone in Warren Buffett’s age group; and, more insidiously, trains Americans from an early age to expect somebody else to cover their medical costs in retirement. And the giant tax handout to employer-provided insurance perversely treats the richest taxpayers as the neediest.

It pays to remember, however, why the pending Supreme Court decision in King v. Burwell is such a lethal threat to ObamaCare. King v. Burwell argues the IRS is illegally misreading the law to grant subsidies to 6.7 million users of the federal ObamaCare exchange known as HealthCare.gov.

King is a threat to ObamaCare because, without subsidies, ObamaCare is nothing. It fixes no problem in our health-care system, except to subsidize more people to consume health care at taxpayer expense. Not that subsidies are always undesirable: They help some people get necessary care. But subsidies do the most good when used sparingly, because subsidies also tend to inflate prices for everyone as well as encourage inefficient consumption that doesn’t improve health and may even endanger health.

In a final irony, many Republicans, seeing the damage an adverse Supreme Court ruling would do, take the statesman-like view that a GOP Congress must stand ready to find a new way to extend subsidies to the 6.7 million people who, since the advent of ObamaCare, expect themselves to be subsidized.

Fine, but let’s also have a major rethink of who should be subsidized and who shouldn’t, across our whole range of health-care programs, including Medicare and the workplace tax benefit.

Never going to happen? It will, if the GOP summons the courage to fix ObamaCare along the lines of the original, rational, “reform” that has motivated health-care thinking for four decades. A place to start would be reducing ObamaCare’s costly coverage mandates so policies would be genuinely attractive to people spending their own money; subsidies could then be trimmed back because fewer people would need subsidies to induce them to buy coverage.

We’ve always said that ObamaCare, for all its flaws, could become the instrument by which responsible reformers renew their push for health care that delivers value for money. In the meantime, however, no worthwhile thoughts about ObamaCare, pro or con, are to be heard from people who count a program as a success just because Americans enjoy receiving benefits at the expense of other Americans.

Another ObamaCare Dream Goes Bust

Health-care cooperatives last year suffered an estimated $377 million in net underwriting losses.
By GRACE-MARIE TURNER And THOMAS P. MILLER

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The Affordable Care Act created a new kind of “cooperative” heralded by supporters of health reform. These Consumer Operated and Oriented Plans, chartered and regulated by the states, would compete with for-profit health-insurance companies and were meant to appease disgruntled advocates of a single-payer and “public option” model for the nation’s health-care system.

All but one of the co-ops are operating in the red. One already has been shut down, and others are in precarious financial condition. Chalk up another ObamaCare failure.

Generous federal loans helped 23 cooperatives to get up and running. They have enrolled more than a million people, according to the National Alliance of State Health Co-ops. Their supporters believed that consumer cooperatives, which must meet the same regulatory requirements as private insurers, would provide better benefits and lower prices than commercial carriers.

In practice, most co-ops have significantly underpriced premiums and grossly underestimated medical claims. Many seek significant premium increases for 2016: 58% for individual plans in Utah, 38% in Oregon and 25% in Kentucky, for example.

Iowa’s CoOportunity Health, which operated in both Iowa and Nebraska, was the first to confront the hard reality of insurance economics as medical claims far outpaced premium income. After the co-op burned through $145 million in federal loans, an Iowa state court in February ordered the organization to be liquidated.

At least 120,000 members were forced to quickly find coverage elsewhere. The Iowa Insurance Division had this helpful advice: “Your coverage with CoOportunity Health will stop, and claims will not be paid after cancellation. If you do not purchase replacement insurance, you may be penalized by the federal government.”

Meanwhile, Standard & Poor’s Ratings Services reported early this year that 10 co-ops had worse loss ratios than Iowa’s in the third quarter of 2014 resulting from a “high medical claims trend and not enough scale to offset administrative costs.” Citing Iowa’s experience, the report warned: “The solvency problems experienced by CoOportunity Health introduce questions about co-ops’ finances in general.”

A separate analysis by the insurance-rating agency A.M. Best expressed concerns “about the financial viability of several of these plans” as losses escalated throughout 2014. Other estimates based on quarterly financial statements filed with the National Association of Insurance Commissioners show co-ops as a whole reported net underwriting losses of $377 million in 2014. Only Maine’s Community Health Options has been operating in the black.

Congress has cut funding for co-ops three times—cuts all signed into law by President Obama—reducing appropriations from $6 billion to $2.4 billion. All the upfront money from the feds has been allocated mostly in the form of “solvency” loans. Most co-ops survive on what little remains unspent from those loans.

New York’s Health Republic Insurance received $265 million in federal loans and had the largest enrollment, with 155,000 members in 2014. Its premiums are significantly lower than established carriers in virtually every region of the state. But the co-op has applied for premium increases in 2016 of more than 14%, with some regions of the state as high as 30%. Industry actuaries believe that those raises will not be enough to offset high claims costs and the exhaustion of federal loan dollars.

Until recently, the Kentucky Health Cooperative had been considered one of the more successful co-ops, with 75% of enrollees in the state’s health exchange. It attracted consumers primarily by offering significantly lower premiums and running the risk of future insolvency.

Yet there are disturbing similarities between this cooperative and the one that failed in Iowa. Kentucky Health Cooperative’s $147 million in taxpayer loans has been exhausted. To maintain a semblance of solvency, it is applying for a big premium increase of 25% for next year and banking on so-called risk-protection payments from other insurers.

The Affordable Care Act provided for risk-protection payments in which insurers with better pricing and higher profits are required to make payments to insurers with inaccurate pricing and bigger losses. Co-ops book these expected payments on their balance sheets as “assets.” But those risk payments are expected to be significantly lower, and they don’t solve the co-ops’ long-term problems.

Consumer Operated and Oriented Plans feed the agenda of progressives who disparage profit-driven commercial health-insurance carriers. But the co-ops are failing. Underpricing risks to gain market share and then counting on further bailouts from taxpayers is a losing business plan, and not much of a political strategy either.

Congress can exercise its oversight function by: 1) making sure that no additional federal dollars are wasted on this program; 2) investigating how $2.4 billion in taxpayer loans has been spent; and 3) determining who will be responsible for paying back the loans.

Ms. Turner is president of the Galen Institute. Mr. Miller is a resident fellow at the American Enterprise Institute. Their report “ObamaCare Co-ops: Cause Célèbre or Costly Conundrum?” is released this week.

A lot of people have to pay back their 2014 ObamaCare Subsidies to the IRS

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A lot of people who received subsidies from ObamaCare in 2014 are finding out that the Affordable Care Act is forcing them to pay that money back to the Internal Revenue Service because the administration did a poor job of spreading important information.

When individuals enrolled in the program at the beginning of last year they had to estimate their income for 2014. The amount of the subsidy that the individual would receive was based on this estimate. Some people thought they could get away with receiving higher monthly subsidies if they intentionally estimated a low income for 2014, while many others simply had no idea what their incomes would be.

What many of these people were not aware of was that they were responsible for informing the government if they had an unexpected rise in their incomes that would invalidate their original estimate. If somebody’s income rose past their original estimate and they did not report it, then they would have received a larger subsidy than the law allowed. ObamaCare officials did not make this information well-known, and now people are paying the price for it.

For example, Janice Riddle is a woman from California and couldn’t believe it when she found out she would owe the IRS money. “I was blindsided that the subsidy has to be paid back,” she said. “I’m in shock…but I have no choice. Do I want to argue with the IRS or the Obama administration?” She has to pay back her entire subsidy, which came out to $470 per month.

Her case is not an isolated incident. For example, early data from some taxpayers shows that 53 percent of Jackson Hewitt clients who received subsidies will have to repay part or all of their subsidies–not a trifling sum, since the average monthly subsidy in 2014 was $264. The largest amounts owed in repaid subsidies so far reach as high as $12,000 .

Some of the people whose subsidies have been reduced or lost can no longer afford the full cost of their monthly premiums, so they are choosing to go without health insurance this year. Sadly for these individuals, the individual mandate penalty for being uninsured (which could be as high as $975 per person next year) suddenly looks like a bargain compared to the true cost of ObamaCare’s unaffordable insurance.

Instead of making health insurance more affordable, ObamaCare is merely transferring costs onto taxpayers. When the subsidies are taken away from people, it’s clear that premiums are way more expensive than officials in the government are leading people to believe. It’s an incredibly complicated law and has been impossible to implement without causing headaches and damage for millions of people.

86 Percent of Those Receiving Obamacare Get Subsidies, White House Says

The Obama administration said Tuesday that 11.7 million Americans now have private health insurance through federal and state marketplaces, with 86 percent of them receiving financial assistance from the federal government to help pay premiums.

About three-fourths of people with marketplace coverage — 8.8 million consumers — live in the 37 states served by HealthCare.gov, the website for the federal insurance exchange. The other 2.9 million people are in states that created and operate their own exchanges.

Sylvia Mathews Burwell, the secretary of health and human services, underlined the importance of subsidies for people in states using the federal exchange — subsidies that could be withdrawn if the Supreme Court rules against the Obama administration in a pending case.

Read more at http://visiontoamerica.com/21246/86-percent-of-those-receiving-obamacare-get-subsidies-white-house-says/#48122jgbvrjfRF40.99

How Obamacare Is ‘Working’

by Michael Tanner
No matter how badly you want something to be true, simply wishing will not make it so. This is a lesson that Obamacare supporters need to learn, as they tell us yet again that the Affordable Care Act “is working.”

The latest claims stem in part from evidence that the number of uninsured Americans has been steadily declining. It is true that the most recent poll from Gallup found that the uninsured rate fell to 12.9 percent in the fourth quarter of 2014, down from 16.3 percent before the ACA passed.

Of course, it would be a mistake to attribute all of that improvement to the ACA. A large portion may be due to falling unemployment as the economy finally emerges from the recession. Since most Americans get their health insurance through their jobs, lower unemployment should naturally reduce the number of uninsured.

Still, the ACA can rightly be credited with some of the gains. If you subsidize something, you should expect to get more of it. And Obamacare heavily subsidizes health insurance.


Increased insurance coverage does not mean increased access to medical care.”
The problem is, that statement uses the term “insurance” very loosely. In actuality, roughly 60 percent of those newly “insured” through Obamacare are actually being enrolled in Medicaid. And Medicaid is hardly the same as real insurance.

While Medicaid costs taxpayers a lot of money, it pays doctors little. As a result, many doctors limit the number of Medicaid patients they serve, or refuse to take them at all.

An analysis published in Health Affairs found that only 69 percent of physicians accept Medicaid patients. Another study, in the New England Journal of Medicine, found that Medicaid recipients were six times more likely to be denied an appointment than people with private insurance. And, according to a third study, when they do get an appointment, they wait an average of 42 days to see a doctor, twice as long as the privately insured.

Just last month HHS’s Office of Inspector General released a report showing how difficult it was for Medicaid patients to gain access to care through Medicaid managed-care programs. IG inspectors posed as Medicaid patients and called designated Medicaid managed-care providers. More than half of listed providers could not be found at the location listed. Others were found but were not participating in the plan, while still others were no longer taking new Medicaid patients. When the investigators were able to get appointments, they faced lengthy average wait times. In 28 percent of cases, they had to wait longer than a month to see a doctor. Ten percent of the time, the wait exceeded two months. A 2012 report from the Government Accountability Office (GAO) confirmed that Medicaid patients faced serious accessibility problems.

And things are about to get even worse.

In an attempt to encourage more doctors to accept Medicaid, Obamacare included a temporary two-year increase in the program’s reimbursement rates. After costing taxpayers roughly $5.5 billion in 2013–14, that increase expired on January 1. Some states are planning to tap their own taxpayers in order to extend the increased reimbursement, but others are unlikely to come up with the money to pay for the extension. In states that don’t pony up their own money — covering an estimated 71 percent of Medicaid recipients — physician reimbursements could fall by as much as 47 percent.

That’s not going to encourage doctors to sign up more Medicaid patients.

Yet, at the same time, the number of people on Medicaid will have increased significantly. Counting normal Medicaid growth as well as the ACA, as many as 20 million more Medicaid enrollees could be seeking care compared with just five years ago.

It doesn’t require an economic genius to realize what happens when increased demand meets reduced supply.

One of the myths of government-run health care has always been the idea that saying people are “covered” is the same thing as giving them health care. We see that in single-payer systems around the world, where universal coverage actually means waiting lists or rationing.

If Obamacare advocates are going to insist that enrollment numbers mean that the ACA is working, they are going to have to come up with a different definition of “working.”

Michael Tanner is a senior fellow at the Cato Institute and the author of Leviathan on the Right: How Big-Government Conservatism Brought Down the Republican Revolution.