Because of Medicaid’s low reimbursement rates, though, the program’s beneficiaries have trouble finding doctors and specialists willing to treat them. Most research suggests that this difficulty leads Medicaid enrollees to wait until a medical problem becomes so severe that an emergency room visit becomes necessary. In 2008, Medicaid patients used ERs at nearly double the rate of the privately insured—45.8 visits per 100 enrollees, compared with 24 visits per 100 for those with private insurance. (For some provider categories, mainly in primary care, Obamacare will increase Medicaid reimbursements to Medicare rates, but only for two years. Medicare rates are much lower than private reimbursements, in any case.) What’s the point of insurance if it leaves you without good access to care?

Most people who will (at least hypothetically) buy the subsidized private insurance that Obamacare makes available are young and healthy, with low expected health-care costs. But Obamacare mandates comprehensive coverage for this population—including free preventive services, like cancer screenings and birth control pills, which only cost $4 a month at Walmart. Forcing such “Cadillac” plans on people who only need catastrophic coverage produces real problems not just in health-care provision, but also across the entire economy. Millions of newly insured, healthy people will flock to doctors’ offices for annual exams they don’t need. Doctors will find themselves with lots of tests to run and minor problems to solve, taking time away from treating seriously or chronically ill patients. Increased demand for additional services will also lead to longer waits for doctors’ appointments, because Obamacare does nothing to expand the supply of physicians in the foreseeable future.