The title of the Patient Protection and Affordable Care Act is being increasingly - and predictably - exposed as a misnomer.
So this latest evidence from The New York Times should come as no surprise:
"Just as millions of people are gaining insurance through Medicaid, the program is poised to make deep cuts in payments to many doctors, prompting some physicians and consumer advocates to warn that the reductions could make it more difficult for Medicaid patients to obtain care. ... The impact will vary by state, but a study by the Urban Institute, a nonpartisan research organization, estimates that doctors who have been receiving the enhanced payments will see their fees for primary care cut by 43 percent, on average."
The ACA boosted funding for primary care under Medicaid in 2013 and 2014. But under the law, that rise expired with the start of 2015 - another stipulation clearly aimed at making the law seem more "affordable."
The departed Congress rejected the White House's 2014 request to extend the increase in Medicaid funding. The new Congress appears primed to turn it down, too.
Who's to blame?
The people who wrote - and those who backed - the ACA on false pretenses.
For instance, President Barack Obama repeatedly pushed the bill with variations on a far-fetched pledge that was put this way on the White House website: "If you like your doctor, you can keep your doctor. If you like your health care plan, you can keep your health care plan."
No, you can't.
Nor should you bank on the pitch of "free" Medicaid expansion that isn't really free. Under the law, after three years of full federal funding for the ACA's boost of Medicaid eligibility to 138 percent of poverty-level income, the states would be responsible for a share of that extra cost starting in 2017 and rising incrementally to 10 percent by 2020.
Though that might not sound like much of a state cost, South Carolina is one of the 22 justifiably wary states that so far have rejected that offer. Past examples of optimistically low expectations of Medicaid costs make that the right call for states (including this one) with already high Medicaid-participation rates.
Meanwhile, the ACA has remained a work in progress since the president signed it into law on March 23, 2010, after Congress passed it without a single Republican vote - and with 34 House Democrats voting against it.
The White House has issued numerous executive orders delaying many of its mandates. That has added to costly confusion while stirring justified objections from constitutional experts.
Then two months ago, video surfaced of MIT Professor Jonathan Gruber, a consultant involved with crafting the ACA, offering incriminating candor about that task. Prof. Gruber explained during an October 2013 panel discussion at the University of Pennsylvania:
"This bill was written in a tortured way to make sure CBO did not score the [individual] mandate as taxes. Lack of transparency is a huge political advantage. And basically, call it the 'stupidity of the American voter' or whatever, but basically that was really, really critical to getting the thing to pass."
And the critical risk of a reduction in doctors taking Medicaid patients is just another consequence of a bewildering legislative behemoth sold on phony premises.