“Medicaid Expansion” Everyone makes out Except the Taxpayer?


“Bubbles we buy with a whole soul’s tasking”

Speaker of The Idaho House of Representatives Scott Bedke and the majority leadership in the Idaho House offered an editorial in Idaho Politics Weekly entitled “Medicaid Expansion is throwing thousands off their insurance”.

Remember—”You can keep your doctor you can keep your plan”?—NOT.

When politicians and government try to find solutions to problems the problems usually become worse.

I proudly sit on the YHI Health Insurance Exchange Board and am proud to have helped over 90,000 Idahoans obtain health insurance, most of them with subsidized commercial insurance who can insure their families’ wages, futures, and incomes should a medical catastrophe place a claim on their wages and future savings. I do have serious concerns, however. The per capita subsidy seems to be growing and I look forward to the day that the exchange can become privatized and run by private brokers and a larger variety of insurance offerings—subsidized and non-subsidized can be offered to Idahoans. I would also hope for an increased “churn” of patients using the exchange. We are now at the 5-year mark of the ACA and we should look at some structural and operational ramifications many of us warned about in 2014.

My biggest concern then and now is how the validation process for qualifying individuals and families for exchange subsidized insurance and for Medicaid patients would work. Just maybe it was designed on purpose not to work at all! In fact an article in the Wall Street Journal on Nov. 19th by Brian Blasé and Aaron Yeiowitz we find out that when the ACA was initiated in 2014 the feds stopped doing audits of State Medicaid eligibility determinations.

This year under President Trump’s CMS Medicaid audits have been reinitiated with the finding that there is a very large amount of enrollment fraud. Spending on illegitimate enrollees has tripled since the beginning of the ACA and now accounts for 20% of Medicaid spending with an overall increase of $72 billion per year. Who benefits from this overspending? Insurance companies, large hospital networks, and hold onto your hats—State Legislatures who look at the increased spending on the gap population that is matched with a 90/10 Federal match compared to in Idaho a 60/40 match for the regular Medicaid population as a previously untapped revenue source that has now become a cash cow!

A better way to look at the 90/10 match is like an adjustable-rate loan. If the match goes to 80/10 the liability of the State doubles. Does anyone think the 90/10 match for the gap population will never be renegotiated by the Feds? The State of Idaho is in fact in the position of supplicant regarding this particular transaction and future State budgets should document this situation as a footnote, just like an auditor would when looking at possible future liabilities.

Put another way, Obamacare and Medicaid Expansion presented States with the opportunity to receive more money from the Federal government. In fact, there is an economic incentive for patients to be classified as “being in the gap”. Because States see Medicaid Expansion as a cash cow they have been incentivized not to audit their enrolled patients. In California, a Federal HHS audit found that 50% of newly enrolled patients did not meet eligibility requirements. Overall nationally it is estimated that between 2.2 and 3.3 million people are enrolled who are not eligible for coverage.

In Idaho, we must make sure that eligibility requirements are maintained and a State Law be passed requiring an annual eligibility audit no matter what CMS requires. The most important reason for doing this is to secure the care of those patients whom Medicaid was originally created to help. Those living on the margins, who through no fault of their own and because of a chronic disease or disability that they have no control over, cannot work and take care of themselves or their families. This population of patients will have an increasingly difficult time finding a primary care doctor for maintenance medical services and an even harder time finding specialists. Ironically, at a time when we have fewer doctors per patient in Idaho than we did 4 years ago, the very group of patients who is being hurt the most is the group we should try hardest to protect.

It is also interesting to note that I didn’t hear from one of these patients during any of “The Expansion Debates” during public forums or before legislative committees. Finally, the people paying for all this are average Idaho citizens who make an average of $53,000 and are seeing their insurance premiums go up annually. Because of increasing co-pays and deductibles, these people who are playing by the rules are finding it more difficult to invest in retirement plans and their children’s education, or a 5-day vacation or band and athletic equipment.

I believe if they knew instead that they are subsiding large hospital networks, insurance companies and State Treasuries —all are seeing net increases in revenues and cash flows, they would become more demanding of those representing them.

Who from this group was able to pay for admission to the Governor’s Cup?

Where does the IMA/IHA/IACI and The COC stand on this issue?

Are the lobbyists looking after the special interests they represent or the people of Idaho? It really is impossible to serve two masters.

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