I do not have a WSJ subscription so I will Mish’s link that quoted from the article.
Congress has an opportunity to reform Medicaid, the nation’s third-largest, and most flawed, entitlement program
Medicaid’s financing is fundamentally broken. Because of ObamaCare, the federal government pays $9 for every $1 of state spending on able-bodied working-age adults, compared with roughly $1.33 for pregnant women and disabled children. That incentive pushes states to favor healthy adults over the vulnerable in enrollment and access to providers and better services.
States also use mechanisms such as the Medicaid provider tax to distort federal-state fiscal responsibility. States tax hospitals and insurers, then use that revenue to increase Medicaid payments back to the same entities. These inflated payments trigger higher federal matching funds. The result: States recycle money through the system and extract substantial federal money with little real state contribution.
To cover their 10% share of ObamaCare expansion costs, many states rely on provider-tax schemes—creating no incentive to spend responsibly and undermining the federal-state Medicaid partnership. Some states, such as California, use these mechanisms to extend Medicaid to illegal immigrants, shifting the cost to federal taxpayers.
If the above is accurate, one would think a biartisan effort could be mounted to fix the problem of overspending on able body adults and stop the states from obtaining/stealing extra federal funding.
“The case I made to my colleagues is: We should ask ourselves in this bill, what will be the legacy that people will remember and talk about 10 years from now, 20, 30, 40 years from now?” Cruz told Semafor afterward.
Dear TJS,
The comparison is incorrect in several ways.
The Federal government had been picking up the ER costs in some fashion for decades. The amount of money has shifted to in a sense to some preventative care lowering the overall cost of care.
The comparison of $9 to $1 if accurate is meaningless. Yes they are able bodied and working. The workers buy O care. The purchase runs through the government. So the $9 is in part worker’s money. The policy can be paid online which implies through the government or directly to the insurer.
There’s nothing wrong with Medicaid. It’s Obamacare that’s robbing us blind with the 20% skim rate to the for-profit health insurers.
When a Medicaid beneficiary “graduates” to Obamacare, they get crappier healthcare with higher deductibles and co-pays – that’s what’s necessary to maintain the 20% skim to the insurer. And with the refundable tax credits, it’s actually more expensive for taxpayers when you move someone off Medicaid and on to Obamacare. We’re paying extra for crappier health care.
And yet, the insurance companies cried about that 20% cap like their heart was being cut out. I have long since forgotten the name, but there was mention made, at the time, of how some companies skimmed far above 20%, one of the worst being in Florida.
Yes prior to Obamacare, there was no limit to the skim rate. There were college health plans where only 5% of premiums paid went for doctors and hospital visits. And universities got a big kickback for every student they signed up which may have been as much as half of the 95% skim rate on the policies.
And this wasn’t illegal. Just good insurance industry business practice.
You see the same thing today with Title insurance when you buy a home. Only 5% of premiums paid is lost to claims – it’s all skim.
I’m just looking at the numbers, it’s much cheaper for taxpayers to have “Medicaid-for-all” than Obamacare with the 20% skim to the insurers.
Of course the political argument is that, “without the 20% of premiums paid bribe to the insurance industry, Obamacare would never have been enacted” – and I don’t disagree with that analysis. It’s just another example of how the bipartisan culture of corruption in Washington fostered by Republicans and Corporate Democrats is keeping the bottom 90% of the income ladder poor and stressed.
Interesting perspective on this in today’s New York Times in a Sen.Chris Murphy interview (of course, Murphy is part of the problem.)
It was originally not wanted by the Obama administration. Originally they wanted a Mecidare-for-All type of program, which they knew would never get GOP support, as well as pushback from the insurance lobby. So this was an olive branch to get support, a necessary evil if you wish.
Medicare for All would have been much cheaper, more efficient. And it would have never passed.
Confused by the dismissive talk about “able bodied people”. You want everyone to have health insurance if at all possible.
That’s actually not confusing at all. In large swaths of the country, the most racist, ignorant and innumerate people are willing to pay a lot more for their health insurance, as long as black and brown people get screwed even more. It’s just nuts.
Read an article the other day, which I now can’t find, that gave a prime example of what is wrong with just about ANY program that gets large. It talked about a patient/user being paid for/covered in California that then moves to Nevada. Medicaid winds up paying for that same person to both states, i.e., that is each state is claiming that person as a resident to get their matching federal dollars. There is little to no incentive for states to update or keep accurate enrollment records.
While I was still practicing, I basically considered a Medicaid case as charity work. Too many times the reimbursement rate did cover the cost of malpractice insurance if I divided that cost equally over all the patients I took care of in a year.
