Obamacare’s massive subsidies still aren’t enough to help some patients, the Milwaukee Journal Sentinel reports:

“Many of the health plans sold on the federal marketplace under the Affordable Care Act have deductibles of $200 or more, even after additional subsidies for people with limited incomes.

“ ‘We are never going to collect that money,’ said John Bartkowski, president and chief executive officer of Sixteenth Street Community Health Centers.”

The clinic serves low-income people, including those who aren’t below poverty and, so, are not eligible for Medicaid, the health care program for the poor. Instead, Obamacare subsidizes the premiums of insurance they buy on exchanges.

But insurers trying to cope with Obamacare’s costly coverage mandates are trying to keep premiums low by offering plans with high deductibles. Obamacare offers further subsidies to cover some of those costs, the newspaper notes, but only for people picking higher-cost “silver” plans. People who choose lower-premium “bronze” plans don’t get those extra Obamacare subsidies.

Health care economist John Goodman pointed out this kind of dysfunction in the Wall Street Journal. The Obamacare website may be working better, but there are three huge problems with Obamacare that won’t go away.

The problems, Goodman says, are that the Obama administration has no workable ideas for lowering the cost of health care – it just shifts costs onto people. And its subsidy system is arbitrary and unworkable.

Then there are the perverse incentives the government sets up for insurers on exchanges:

“Under ObamaCare, insurers are required to charge the same premium to everyone, regardless of health status, and they are required to accept anyone who applies. This means they must overcharge the healthy and undercharge the sick. It also means they have strong incentives to attract the healthy (on whom they make a profit) and avoid the sick (on whom they incur losses).

“The result has been a race to the bottom in access and quality of care. To keep premiums as low as possible, the insurers are offering very narrow networks, often leaving out the best doctors and the best hospitals. By keeping deductibles high and fees so low that only a minority of providers will accept them, the insurers are able to lower their premiums, thus attracting still more healthy individuals at the expense of overall care.”

Goodman’s point: This isn’t bad-actor insurers. Instead, this is where Obamacare’s rules lead. His prescription:

“Getting rid of the mandates, letting people choose their own insurance benefits, and giving everyone the same universal tax credit for health insurance would be a good start. More easily accessible health savings accounts for people in high-deductible plans is another good idea.”