I make two predictions on the effect of the Obama presidency on low income earners in the US:
1. The health insurance coverage rates will be much larger, close to 100%, especially if Obama gets two terms.
2. Low income earners will have more trouble accessing health care. This will be especially true for the lowest income earners.
I think these are both compatible and, in fact, will come true. Obama will trumpet the first achievement, the second will be reported sometimes as a mistery with headlines reading “in spite of new law, poor worse off.”
I remember an economist on NPR commenting on the effects of the Massachussetts mandate: the law achieved its most important objective: almost everyone now carries a plastic rectangle with the words “health insurance.” ObamaCare, by relying so much on Medicaid to address the access problem for low income populations, will be similar. More and more people will carry a card with the word “Medicaid” written on it. Unfortunately, this is being done at the same time as Medicaid budgets are being cut. The per-beneficiary budget will go down. This can only mean one thing: people on Medicaid will not get many health care services.
The biggest losers are, of course, the people who were already elligible for Medicaid before Obama, the lowest income groups. They are now worse off. The people who were previously outside the system and now inside it might be slightly better off (after all, they will get some service). This is redistribution from the bottom to the near bottom of the income pile.