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Repealing the Affordable Care Act is a top priority for President-elect Trump. The Left is already sounding alarms, with many pointing to the millions of newly insured Americans who benefit from the law.

It’s right to be concerned about the fate of those who’ve enrolled in the Affordable Care Act. But it’s also important to understand what the Affordable Care Act’s insurance expansion actually was: For the most part, it was a large-scale expansion of Medicaid, the federal government’s health insurance program for the poor.

While enrollment for the law’s exchanges has been disappointing, a new analysis of state projections shows Medicaid expansion resulted in enrollment levels 110 percent higher than expected.

Indeed, nationwide Medicaid enrollment has increased by 15 million since the Affordable Care Act was passed. The majority of people that Democrats count as newly insured by the law are actually insured by Medicaid — a government program, not private plans.

This is relevant as the healthcare debate continues, because taxpayers who fund Medicaid (and subsidies for plans in the Affordable Care Act exchanges) deserve to know what bang they are getting for their buck.

Medicaid is notorious for low and slow reimbursement to healthcare providers, which means patients often face limited options for doctors (many of whom won’t accept Medicaid, or limit the percent of patients they see with Medicaid), and end up waiting longer for needed care.

Several studies since Medicaid expansion show that these patients end up in emergency departments, often seeking care for non-acute medical problems. This is sad evidence of the hardship that many Medicaid patients face in getting doctors’ appointments. And it’s dangerous for patients who are truly facing emergencies, as congested ERs make it harder to treat everyone.

It’s no surprise that Medicaid patients are diagnosed later with health problems and end up with inferior outcomes compared to privately insured patients. And many, perhaps up to 50 percent, of Medicaid enrollees under the Affordable Care Act were privately insured before the expansion made them eligible.

This is called the crowd-out rate. In other words, the law moved millions of Americans from private health insurance (and access to superior healthcare) into a public program known for providing worse outcomes.

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In fact, other data suggests that Medicaid patients do no better or are sometimes even worse off than the uninsured. And Medicaid’s performance is likely to be getting worse, not better, as the expansion puts further strain on a program that was dysfunctional even before millions of new enrollees were added.

Low-income Americans deserve much better than to be dumped into Medicaid and used as political hostages in the healthcare debate. Conservatives who want to repeal the Affordable Care Act and replace it with something better should ensure a smooth transition for those who are currently relying on the law’s unkeepable promises.

But we should keep the dire warnings that Affordable Care Act repeal will take away health insurance benefits from millions in perspective: How much is that coverage really worth if it doesn’t translate to quality healthcare and improved outcomes?

Hadley Heath Manning is a contributor to the Washington Examiner’s Beltway Confidential blog. She is a senior policy analyst and director of health policy at the Independent Women’s Forum, and a Tony Blankley Fellow at the Steamboat Institute. Thinking of submitting an op-ed to the Washington Examiner? Be sure to read our guidelines on submissions.

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