California’s Medi-Cal expansion failed over the last three years to deliver on its promise to cut costs, due to a 44 percent increase in the number of visits to high-cost hospital emergency rooms.

President Barack Obama promised in a nationally televised healthcare speech in 2009 to a joint session of Congress:

One of the areas where we can potentially see some saving is — a lot of those patients are being seen in the emergency room anyway, and if we are increasing prevention, if we are increasing wellness programs, we’re reducing the amount of emergency room care, then that frees up doctors and resources to provide the kind of primary care that will keep people healthier, but also allow them to see more patients and hopefully give more time to patients, as well.

Breitbart News reported that California had been the primary beneficiary of the Obamacare ‘Medicaid expansion’ funding by capturing 24.3 percent, or 3.5 million individuals, of the 14.4 million new Medicaid enrollees nationwide. By the end of 2016, California’s Medi-Cal enrollment was about 13.5 million individuals, or 34.5 percent of the state’s 39.1 million residents.

Just 18 days before President Trump would take office on January 20, House Minority Leader Nancy Pelosi (D-CA) claimed that Obamacare had achieved its mission to “increase access, to improve quality and to lower cost.” Ms. Pelosi two days later trumpeted the virtue of Obamacare cost containment, but she warned that the Republican effort to “repeal and delay” Obamacare’s growth was an “act of cowardice” that would drive up costs.

However, the latest report from the California Office of Statewide Health Planning and Development reveals that rather than containing costs by enrollees seeking primary care services at low-cost doctor’s offices, Medi-Cal enrollees visits to high-cost hospital emergency rooms have skyrocketed by 44 percent over the three years since the beginning of Obamacare’s Medi-Cal expansion.

The biggest failure of Obamacare to move more Medi-Cal patients into primary care office visits is the ridiculously low primary reimbursement rate for a primary care doctor office visit. Foolishly predicting that Medi-Cal expansion would result in a huge volume increase, California cut primary care doctor office visit reimbursements by 10 percent, according to Modern Healthcare.

According to Medi-Cal’s website, reimbursement for a primary care doctor office visit averages $37.50, but it can be as low as $18.10. As a result, the percentage of California primary care physicians participating in Medi-Cal plunged from 69 percent in 2013 to 63 percent in 2015, while specialty care physicians’ participation in Medi-Cal likewise dropped from 70 percent to 64 percent.

Many of the same doctors that stopped treating Medi-Cal enrollees in their own primary care offices have signed up with hospital emergency rooms to provide the same Medi-Cal primary care services to the same enrollees. But the huge difference is that hospital emergency room reimbursement under Medi-Cal primary care is $53.40 for a primary care visit, or about 43.44 percent more than a doctor is paid in his private practice office.

All the states would receive a per capita amount of Medicaid funding under the Republican Senate’s proposed restructuring of Obamacare. If the bill passes, California would lose $30.3 billion of its $82.0 billion in Medicaid funding to the other states.