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Medicaid Enrollment Errors

By October 30, 2015Commentary

As it turns out, the only real and lasting insurance gain caused by the reform law is via the Medicaid expansion.  As premiums continue to rise beyond what is possibly affordable on the exchanges, those will likely wither, except for those people who get a full subsidy.  The Medicaid expansion, like the rest of the reform law, apparently is riddled with executional incompetence, as verified in a recent Government Accounting Office report.  (GAO Report)   After expansion Medicaid is covering over 70 million Americans, an astounding number for a program that was originally designed to help only the truly impoverished who had little ability to work.  Many of the people who are eligible for Medicaid might also qualify for subsidies if they got coverage on a public exchange.  The reform law required that there be a solid process to prevent people enrolling in Medicaid who weren’t eligible, and to keep people from getting subsidies if they shouldn’t.  Prior reports have already demonstrated that a lot of people are getting Medicaid coverage who should not and this report found that there are inadequate controls to prevent double-dipping and to make accurate eligibility determinations.  While not quantified in the report, based on the average costs of these enrollees and average subsidies, we are likely talking about billions of dollars of inappropriate spending.

The Medicaid expansion is expensive and the states and their taxpayers have had that hidden from them for the first few years while the federal government picks up most of the cost.  But soon it will be dumped on the states and even in the relatively good economic times we currently enjoy, most states have serious budgetary issues.  They simply will be unable to afford the program as the reform law envisioned it.  And I keep asking, why are we giving people free, benefit rich coverage with almost no restrictions, when we are forcing most low and middle-income working Americans to live with crappy coverage with high premium sharing and high cost sharing?  No fairness there.

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