Obamacare provided a temporary payment boost to doctors covering Medicaid patients, to help ensure that there were plenty of providers available to the swelling group of patients when the law was implemented. That provision, however, was only for 2013 and 2014, and now
has expired. The Urban Institute estimates that doctors who have been receiving these enhanced payments for primary care will see those reimbursements cut by 43 percent, on average. Which means that a healthcare program that is far less expensive that the rest of our healthcare system is
going to get even cheaper, possibly too much so.
The chart shows that Medicaid spending per beneficiary is lower than average per-capita health costs. It also shows that, as of 2013, Medicaid spending was lower, in real dollars, than it was a decade earlier. (The uptick in 2013 probably reflects, in part, the extra money for primary-care doctors provided by Obamacare.)
The optimistic interpretation is that Medicaid is a tremendously efficient program. The pessimistic one is that state administrators of Medicaid are pushing payments to unrealistically low levels.
The second interpretation is probably closer to the truth. And at some point, conservative warnings about the dysfunctions of Medicaid will become self-fulfilling: Providers will stop participating, pushed out by spending restraint that no other health-insurance program would dare match.
That's the Republican formula—starve a government program to the point that it can't function, so that they can then point at it as an example of how government doesn't work. Medicaid, though, is a tremendously
efficient program which provides for a lot more health care to beneficiaries per buck spent than private health insurance. Between that and the fact that the primary beneficiaries are poor people and children, no wonder Republicans want to strangle it.