Obamacare goes against two values that should be no-brainers: prioritizing American citizens over non-citizens, and prioritizing help for the disabled over assistance for able-bodied adults.
Prioritizing Non-Citizens Over American Citizens
Obamacare includes special provisions that allow many legal, non-citizen residents to qualify for federally subsidized insurance and, in so doing, offers these non-citizens more and better coverage options than American citizens.
The law as implemented creates two inequities that put American citizens at a disadvantage compared with non-citizens.
First, in states that expand their Medicaid programs, citizens with incomes under 138 percent of the federal poverty level will be automatically enrolled into Medicaid, while non-citizens will receive subsidies to purchase coverage in the Obamacare exchange.
Several studies show that patients with Medicaid coverage have worse outcomes than the uninsured, and some Medicaid beneficiaries do not consider the program “real insurance.” Yet Obamacare dumps millions of American citizens into this troubled program, even as it grants many non-citizens the opportunity to pick health plans of their choosing.
Second, in states that do not expand their Medicaid programs, non-citizens will be able to purchase subsidized health insurance in the exchanges, while American citizens below 100 percent of the poverty line may not qualify for subsidized coverage at all.
It simply doesn’t make sense to offer non-citizens more and better coverage options than American citizens. This potentially encourages immigration to the United States by those seeking to benefit from taxpayer-funded welfare programs, which increases the incentives for people not to become citizens, and thus full, integral members of our civic society.
Prioritizing Able-Bodied Adults Over Disabled Americans
A public safety net is necessary for those truly in need. But by spending more than $700 billion on its massive Medicaid expansion, Obamacare puts a greater emphasis on covering able-bodied adults than the disabled, which Medicaid was originally intended to serve.
By extending health coverage to those who should be able to work, Obamacare could jeopardize the coverage of disabled Americans. And by subsidizing health coverage for millions of unemployed and underemployed, Obamacare could accelerate the development of a permanent underclass that has little financial incentive to work.
Given its poor outcomes for patients, Medicaid needs significant changes. However, true reform cannot come from adding able-bodied adults to an already overburdened program. Instead, Congress should focus on improving Medicaid’s quality of care, while restoring its emphasis on providing a safety net for the truly needy.
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