Believe it or not, physicians even do better caring for the uninsured than they do caring for Medicaid patients. Two MIT economists, Jonathan Gruber and David Rodriguez, have found that three-quarters of physicians receive lower fees for serving Medicaid patients than they do for the uninsured, because many people without health insurance are still able to pay out-of-pocket for routine health expenses. (Gruber was the intellectual father of Obamacare, and remains an outspoken advocate of the law.)

2) Overall, Medicaid expansions do not lead to more doctor visits

Chapin White looked into this problem by examining the State Children's Health Insurance Program, or S-CHIP, which was created by Congress in 1997 as a way of expanding Medicaid to lower-income children who were above the income thresholds of traditional Medicaid. He found that CHIP was "not associated with any change in the aggregate quantity of physician services [consumed]," and concluded that "coverage expansions...do not necessarily increase physician utilization."

The main reason for this non-effect, he surmised, was due to the fact that CHIP paid physicians less for their time and expenses. "Increasing Medicaid fees," he wrote, "is...clearly related to a reduction in non-[cost-sharing]-related access problems among both low- and high-income children."

White compared children in states which had undergone large CHIP expansions, and compared them to children in states with smaller expansions. He also examined increases versus decreases in Medicaid physician fees. He found, surprisingly, that physician utilization was lower in the states with the largest CHIP expansions, and that expansions of CHIP led many children to lose private insurance as the government program crowded out the private sector. "Supply-side effects of CHIP--either the use of managed care tools or the relatively low reimbursement rates, or both--may have limited the utilization effect of the coverage expansion," White concluded.

3) Obamacare's Medicaid expansion could worsen physician access

As the below table shows, 11 percent of children in the lowest income quartile, who were uninsured, gained insurance; however, 13 percent of children in that quartile who had private insurance lost it, while Medicaid/CHIP expanded by 23 percent of children. In other words, for every two children who gained Medicaid coverage, one lost private coverage.



In the third-lowest and second-lowest quartiles, the proportion of those gaining Medicaid coverage and those losing private coverage were almost identical, suggesting that Medicaid was replacing private coverage in the majority of cases. Those individuals who are subject to the replacement will have poorer access to health care, because Medicaid pays less than private insurance. It is this cohort, represented especially by White's third-lowest quartile, that is subject to Obamacare's expansion of Medicaid.