Dean and CEO of Johns Hopkins Medicine Edward Miller writes in the Wall Street Journal:

Both the House and Senate health-care reform bills call for a large increase in Medicaid—about 18 million more people will begin enrolling in Medicaid under the House bill starting in 2013, Centers for Medicare and Medicaid Services (CMS) Actuary Richard Foster estimates.

A flood of new patients will be seeking health services, many of whom have never seen a doctor on more than a sporadic basis. Some will also have multiple and costly chronic conditions. And almost all of them will come from poor or disadvantaged backgrounds.

We’ll meet the demands placed on us because serving poor and disadvantaged populations is part of our century-old mission. But without an understanding by policy makers of what a large Medicaid expansion actually means, and without delivery-system reform and adequate risk-adjusted reimbursement the current health-care legislation will have catastrophic effects on those of us who provide society’s health-care safety-net. In time, those effects will be felt by all of us.

Read Miller’s entire op-ed here.

Abortion, the public option, and the individual and employer mandates are all important issues in the health care debate. But Miller’s op-ed reminds us that not enough attention has been paid to the fact that in both the House and Senate bills, almost half of all new insurance coverage gained through “reform” is actually accomplished through expansion of Medicaid eligibility requirements. The only reason Medicaid carries such a heavy load under Obamacare is because the Congressional Budget Office scores it as an inexpensive way too expand health insurance coverage. But Medicaid does not provide ideal health care. That is why single payer advocates push for “Medicare for All” not “Medicaid for All” … which is what Obamacare may actually deliver.


Go here to see a larger, printable PDF of the chart.