The problem is that the program has increased by a third in membership the span of six years (almost 48 million in 2009 to 65 million last year) while the economic base that pays for Medicaid still grows slower than the rate of growth in the program (and of health care cost as a whole).
That 1/3 increase in enrollment is not a problem so much as it's how the law was designed. More support for lower income people by expanding Medicaid and Medicaid receipts to support them. That initial growth is accounted for in the law's budgeting. As for the rate of growth, I'm wondering what data you have on that. In aggregate, the growth rate in per-capita healcare spending has declined over the past few years, averaging about 1.3% in real terms per year. Not great, but also not something that looks to be outstripping our ability to pay for it. That includes Medicare spending, so it's possible that the Medicaid data is drastically different and being averaged out, but I don't have a clean dataset in easy reach. Based on private market trends, I'd be surprised if Medicaid turned out to be growing at a uniquely high per-capita rate.
Only if you count Medicaid as part of that.
This one gets me every time. Of course you count Medicaid as part of that! A huge part of the law was getting more lower income people healthcare by providing it through Medicaid.
If they had implemented a 100% coverage single payer system, I bet there would be people who say that it didn't expand access to healthcare "unless you count that government plan." It's one thing if we accidentally made everybody too poor to afford anything but public assistance, but the Medicaid expansion was completely intentional. It was the answer to the question, "How you going to get health insurance to lower income people?"
While I don't have a lot of experience with the program, it does appear to be going downhill to me, especially with below market rates for most medical care.
I don't really know how to respond to feelings of vague unease with the quality of the program. Are you really asserting, as you imply below, that Medicaid is no better than just showing up at an emergency room? I don't think there's a lot of data to support that. The mainstream consensus is quite the opposite.
What amazes me is that the program is working more or less as designed, costs are running lower than expected, the economy has failed to collapse as predicted, and people are still saying everything was perfectly fine when stumbling into an emergency room to be stabilized and sent home was "healthcare." The idea that there have been no objectively measurable improvements to the situation baffles me.