There has been a considerable amount of press written and spoken regarding the Patient Protection and Affordable Care Act, Also known as the ACA or Obamacare. Obamacare was passed as a healthcare plan and approved by the Supreme Court as a tax. Obamacare is Obamatax. This column, and its sister site, has written numerous articles regarding the ACA and numerous columns regarding Medicare, Medicaid, and Social Security. The Medicare and Medicaid Trustees, as well as the Social Security Trustees, have been requesting increases in payroll taxes for years. This column has detailed this situation for years. One column was "Obamacare: Fewer covered by Private Insurance - More Covered by Medicare and Medicaid." One column written last Fall was "Obama(s)care:Rising Premiums, Deductibles, Responsibilities." The most recent column was "Uncle Sam: Trust Fund Baby  Gone Bust." We have been balancing on-budget spending with off-budget revenue for years. Medicare and Medicaid are supposed to be "off-budget." Why are we having such problems? The percentage of companies with under 50 employees who are offering healthcare benefits has been declining. They either have to go without insurance, buy insurance on their own, or rely upon Federal Programs.

Obamacare caused a spike in Medicaid Enrollment.Obamacare was proclaimed to be a success early in its adoption because tens of millions of people obtained insurance . The truth of the matter was that we saw a spike of 12 million people joining Medicaid through Medicaid expansion programs in the states that accepted the Obamacare exchanges.

The Center for Medicare and Medicaid Services have seen their Outlays Surge since the adoption of the ACA. We were spending just under $1 trillion a year on Medicaid (CMMS) during fiscal year 2009. We were spending 1.113 trillion on CMMS by 2013. The first full year of adoption of the ACA we saw that cost spike by 73.7 billion to 1.186 trillion dollars. The number jumped by 109.8 billion during FY 2015. The outlays jumped again, this time, by 120.6 billion dollars during FY 2016. The fiscal year ends this September. We have already spent 929 billion dollars, as of May, compared to 919 billion dollars compared to FY 2016. So far, according to the monthly reports we have only seen an increase of 1.1 million new Medicaid recipients this year (roughly 1.5%.) If the rate of growth of outlays is comparable to the past two years, then we will see another 8.5% jump in spending. This will mean that we will exceed 15.537 trillion dollars.

Over 50% of the people on Medicaid are Children. The CMMS released a report last week that received little, if any, attention. The April Report on Medicd and CHIP eligibility and enrollment was required by the ACA. The website touts that over 74.5 million people are enrolled in Medicaid and the Children Health Insurance Program (CHIP.) This number will rise by the end of the fiscal year. The webite explains that over 50% of those who are enrolled in Medicaid are children. This is a problem as the number of Medicaid. Even with the expansion of Medicaid there are over 29 million people without health insurance, as of September 2016.

We expanded Medicaid Enrollment by Offering Medicaid Coverage to Inmates.`One of the best sources for information on healthcare is the Kaiser Family Foundation. They have information on their website broken down by state. Their website has an article  from 2014 titled "Health Coverage for the Adult Criminal Justice Involved Population."   Subsequently they have released the 2016 Article "Connecting the Justice Involved Population to Medicaid Coverage and Care: Findings from Three States." Arizona, Massachusetts and Connecticut are the three states. Will this expansion be detailed in the Trustees report this year?

Enrollment has increased in Medicaid since the adoption of the ACA. Medicaid outlays have grown during the past three years under the expansion of Medicaid. We will spend over 1.4 trillion dollars this year on the CMMS. If reform does not occur then we will have to see the type of payroll tax increase to offset the changes in the number of covered employees. The real solution is to get people off of Medicaid and CHIPS and onto employer provided health insurance.If incomes increase then revenues for Medicaid and Medicare will increase.

It's the economy.