Waste, fraud and abuse – Oh, my! – The health care blog

By Kim Bellard

Thus, the house adopted their “big and beautiful ticket”, by the narrowest margins. Crucial for the bill are the significant savings of Medicaid, which would have taken lips, but now they take care to explain it as a simple reduction in “waste, fraud and abuse”, after having realized that many Maga voters depend on Medicaid.

A large part of these economies come from the work requirements proposed for the beneficiaries of Medicaid, long a favored republican tactic that the Biden administration has ceased to reject. President Mike Johnson sees himself very important. People affected by work requirements, he insisted on Face the nation::

If you are able to work and refuse to do so, you fraud the system. You deceive the system. And no one in the country thinks it’s true. So there is a moral component in what we do. And when you make young men work, it is good for them, it is good for their dignity, it is good for their self -esteem, and it is good for the community in which they live.

He is convinced that, instead of working, too many of them – especially young men – “playing video games all day”. He and other Republicans want to give Medicaid to what they consider his initial objective: “He is intended for young people, you know, single and pregnant women and the disabled and the elderly,” said President Johnsom. “But what is happening right now is that you have a lot of people, for example, young men, valid workers, who are on Medicaid. They don’t work when they can.”

He is generally right to say that, for most of his existence, Medicaid was not really a program for the poor as much as for certain types of poor, in particular low -income pregnant women and children, and medically impoverished. It took Obamacare to widen the coverage to all people under the poverty line, although the Supreme Court allowed the States to decide if they wanted to do so, and ten states have still not done so.

It is, in fact, a moral question, but not the genre that President Johnson likes, to know if there is a moral imperative to give more people, especially the poor, a health coverage.

The question of these beneficiaries of MEDICAID NO that does not work is a shiboboleth. The Kaiser Family Foundation, for example, noted that “92% of Medicaid adults work (64%) or have circumstances that can qualify them for an exemption.” A CBO 2023 analysis questioned that these work requirements would not have much impact on the number of beneficiaries of Medicaid who work. Work requirements are a solution looking for a problem.

What we know about the work requirements, derogation programs in Arkansas and Georgia, is that they indeed reduce the number of people on Medicaid, but largely by making the verification of eligibility more difficult. The requirements are confusing, the processes that the recipients / potential beneficiaries must follow are heavy, and the mechanisms necessary to supervise them are expensive (or, depending on your point of view, lucrative for certain suppliers).

It is not a question of obtaining valid people on Medicaid to work, and it is not “waste, fraud and abuse”; It is a question of obtaining fewer people registered in Medicaid.

The calls to return Medicaid to its original objective seem very selfish. Medicare, for example, did not originally cover people with ESRD or disabled people under the age of 65. Social security did not originally cover agricultural workers or self -employed workers, and did not include the advantages for disabled or retirees (spouses and children). We could save a lot of money by returning these programs to their original ends, but these are bridges that the Republicans are not yet ready to cross … again.

If we think Medicaid is not the right program for many poor, well, it’s just a discussion. Medicaid has more than its share of problems, the least of which are not low reimbursement rates in most states and a lack that results from participating health care providers. Many poor could, in fact, be better served by simply leaving them to register for an ACA plan.

Unfortunately, however, the ACA was not designed for the poor, its premium subsidies and its cost sharing reductions Do not apply to people with income from federal poverty. It has been assumed that these people would all be covered by the expansion of Medicaid. Of course, low -income people could get an ACA plan, but it is difficult to see how they could afford bonuses or pay deductibles / coastal amounts for the care they may receive.

Perhaps these young low-income video games could find a job, but there is a good chance that their employers will not offer health insurance, or, even if they did, the contribution of premium of the required employee would be unaffordable, or they could try to obtain an even more inaccessible ACA plan. For better or for worse, in the convoluted system, we have Medicaid is the best place for them.

The moral component that President Johnson and others – many of whom claim to be devout Christians – seem to be missing is that in the richest country in the world, no one should obtain the health care they should have because of its cost. The best way in which the United States has found to try to do so – and it is an extremely imperfect solution – is to obtain more people covered by a form of health insurance. The ACA has reduced the number of people without insurance almost half, but that still leaves nearly 30 million people without coverage.

It is estimated that the “big and beautiful bill” would add more than 10 million people to the ranks of people not insured, most of them, but not all, people losing the coverage of Medicaid. It could also, in the sense, more paralyze hospitals and security professionals, more exacerbating the impact.

Thus, when you hear the Republicans talk about “waste, fraud and abuse” in Medicaid, what they say is that some people do not deserve to obtain health care (similar ribbon cuts mean that some people do not deserve to eat). I have trouble with that, and I don’t even need to check my Bible to be about sure that it is morally false.

Whether or not these people play video games.

If they want to go after fraudulent invoicing, over-treatment, bribes, etc., yes, I am on board for having targeted this kind of waste, fraud and abuse. But kicking the poor when they are already broken down, no.

Kim is a former Emarketing leader in a major blues plan, editor Dye.ioand now a regular THCB contributor