Medi-Cal has failed to fulfill its stated goal of improving health-care access for the indigent and disabled

See Medicaid’s Potemkin Health Coverage by Allysia Finley of the WSJ. Excerpts  

"Medicaid’s Potemkin Health Coverage California is a case study: One patient suing the state says she went to Mexico to get her gall bladder out."

"Medicaid operates as an open-ended entitlement, meaning the federal government covers a predetermined share of state spending, regardless of the total cost."

"ObamaCare encouraged states to expand Medicaid so that it covers people with incomes up to 138% of the federal poverty line—in other words, up to $16,400 for an individual. After the Supreme Court struck down ObamaCare’s mandated expansion, the federal government induced states to sign up by initially assuming 100% of the cost for these people. That will slip to 90% in 2020, though it’s still a bargain for most states.

Imagine if Amazon gave you money back whenever you bought things on its site—and you got more money back the more you spent: You’d buy things you don’t need, and things that might be purchased for less elsewhere."

"The problem is that Medi-Cal reimburses providers at between a third to half of the rate that private insurers pay. Doctors complain they lose money on each Medi-Cal patient they see. That’s why only 55% of primary-care physicians accept new Medi-Cal patients, according to a recent study from the California Health Care Foundation. When physicians were asked why they cap the number of Medi-Cal patients they see, 78% cited the program’s low payments."

"half of the primary-care physicians in the Bay Area do not treat new Medi-Cal patients; most cite low reimbursements, time-consuming paperwork, and payment delays."

"The shortage of doctors accepting Medi-Cal, together with the surge in enrollment, brings patients to the emergency room instead. ER visits by Medi-Cal patients rose 75% over the past five years"

"in the first three quarters of 2016, Medi-Cal enrollees in the county were more than twice as likely as the privately insured to visit the ER for outpatient care."

"Now Medi-Cal patients with minor maladies are inundating ERs, where they get free care and take up beds needed for patients who require urgent treatment."

"a visit to the ER costs five times as much as an appointment with a primary-care physician. But California has little reason to care, since Washington pays most of the bill."