Sunday, January 19, 2014

Medicaid Fraud and You

From its inception, Medicaid is a program that was intended to provide medical care to those who are either at or below the national poverty thresholds.  So, one would think that, if there are 46.5 million people in poverty in America in 2012, there would be about 46.5 million in the Medicaid program in that same year.  Instead, Medicaid enrollment hit a record 72.6 million in that same year; or, a whopping 59% more people on Medicaid than in poverty.

While it's true that some states have expanded their Medicaid programs beyond the Federal guidelines for poverty, those states certainly haven't done so by a factor of 59%.  The reason being that Medicaid is the second highest expense behind education. Therefore, the states can't just wildly expand the program without completely blowing their budgets.

The true fact is that Medicaid is ripe with fraud.  Not only do some enrollees use fraudulent income data to enter the system; it is also a system that is weak in verifying when persons are no longer eligible for this benefit.  So, the rolls just keep on growing.  Even if the number of those in poverty starts to decline.

Obviously, any state or federal taxpayer is a big loser because this fraud is being primarily funded by state taxes with dollar-for-dollar, matching federal funds.  Beyond that, there is a vicious circle that is being created that, not only hurts any person with private insurance (whether purchased alone or through an employer) but, actually, hurts those who are legitimately in need of Medicaid.

Because Medicaid is such a big and fast growing expense, states have opted to control costs by reducing the amounts they reimburse the health care providers.  At the same time, the federal government has, too, reduced its reimbursements for care under Medicare.  This, in turn, has resulted in those same  health care providers charging private insurers higher and higher rates in order to offset the losses incurred in caring for Medicaid/Medicare patients.  This fact is well borne out by the following chart:


So, not only does the average American pay higher taxes because of Medicaid fraud; their cost of health insurance is also going up.  But, sadly, the "true" Medicaid patients are also being hurt in the process.  That's because whenever reimbursements are reduced, fewer doctors and hospitals, especially the good ones, will accept these patients.  The result is simple: Less quality of care for people on Medicaid.

Under ObamaCare, the already-broken Medicaid is being expanded by another 33%.  That will only result in more fraud, higher taxes and/or reduced reimbursements, higher private insurance rates, and lower quality of care for the true needy of this country.  This is just another reason why ObamaCare is so wrong for America.

References:

46.5 Million In Poverty: http://www.huffingtonpost.com/2013/09/17/poverty-america-census_n_3940812.html

Record 72.6 million on Medicaid: http://cnsnews.com/news/article/72600000-record-number-medicaid-2012-outnumbers-populations-france-and-uk

California Cuts Medicaid Reimbursements by 10%: http://www.bloomberg.com/news/2013-10-04/california-cuts-medicaid-payments-amid-wave-of-new-users.html

Census Bureau: Income, Poverty and Health Insurance Coverage in 2012: http://www.census.gov/newsroom/releases/archives/income_wealth/cb13-165.html

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