Shifts in the sources of health insurance (and loss of insurance for some people) would affect the health care people receive and what they pay for it. Some people would end up without health insurance. People without health insurance are likely to receive lower quality care and pay more than insured people do. Many, but not all, people who end up with a different source of insurance would pay higher premiums than they would for Medicare and spend more out of pocket. The quality of health care could differ as well, in various ways. For example, people with private health insurance might have better access to physicians than they would under Medicare. Some people on Medicaid could have more difficulty obtaining services, but others could have access to health care with lower out-of-pocket costs than they would have under Medicare. The provisions of PPACA would make not having health insurance through Medicare or an employer less onerous than it would be otherwise. Virtually everyone affected would have access to health insurance, either through Medicaid or through exchanges. Although in many cases the premiums in the exchanges would be higher than 18. Some dual Medicare and Medicaid enrollees currently qualify for full Medicaid benefits; others qualify only for assistance with certain types of Medicare cost sharing. they are for Medicare, the insurance would be priced without regard to health status and with limited adjustments for age.
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