Over a 6-month period, the OIG found in California:
For our sample of 150 beneficiaries, California made Medicaid payments on behalf of 112 eligible beneficiaries. However, for the remaining 38 beneficiaries, California made payments on behalf of ineligible beneficiaries (e.g., a woman who did not meet eligibility requirements for the newly eligible group because she was pregnant) and potentially ineligible beneficiaries (e.g., a beneficiary who may not have met the residency requirement). On the basis of our sample results, we estimated that California made Medicaid payments of $738.2 million ($628.8 million Federal share) on behalf of 366,078 ineligible beneficiaries and $416.5 million ($402.4 million Federal share) on behalf of 79,055 potentially ineligible beneficiaries. (These estimates represent Medicaid payments for fee-for service, managed-care, the drug treatment program, and mental health services.) These deficiencies occurred because California’s eligibility determination systems lacked the necessary system functionality and eligibility caseworkers made errors. We also identified a weakness in California’s procedures related to determining eligibility of individuals who may not have intended to apply for Medicaid.
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Through its regime of subsidies, penalties, and federal regulations, the Affordable Care Act (ACA) made health insurance affordable to millions of people who were uninsured because they earned too little or had preexisting conditions. But it also made insurance more expensive for millions who used to be able to afford it. Between December 2013 and January 2017, average premiums more than doubled, and individual markets were in turmoil.
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I come to bury IPAB, not to praise it.
Like Brutus and his co-conspirators wielding the knife against Julius Caesar, the budget deal Congress passed in the early morning hours of February 9 put to death an idea whose time apparently never came and, now never will. The Independent Payment Advisory Board (IPAB), created in the Affordable Care Act (ACA), is history.
It is a rare moment when Republicans and Democrats agree on something they don’t like about the ACA. Behind IPAB’s demise is a belief that Congress shouldn’t delegate its powers to determine Medicare’s rules and a massive political force that reinforced that belief.
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The most significant federal entitlement reform in our lifetime was a little noticed provision that Democrats included in the Affordable Care Act (Obamacare). The provision garnered almost no attention from the mainstream media or even from most conservative commentators. Yet according to the Medicare Trustees report that followed, this one provision eliminated $52 trillion of unfunded federal government liability – an amount that was more than three times the size of the US economy.
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Here’s what the Department of Health and Human Services could do:
- Relax rules so companies of all sizes can take advantage of HRAs. Medium-sized and large employers want the same option of setting up HRAs for workers to buy ACA coverage, said Chris Condeluci, who worked on the ACA as a Senate GOP staff attorney.
- Now that the individual mandate has been repealed, the administration could open the door for companies “to provide funds to buy noncompliant coverage,” said Gary Claxton, a vice president at the Kaiser Family Foundation.
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Earlier this week, the Trump administration restored Obama-era rules that allow individuals to buy affordable insurance plans that aren’t bound by Obamacare’s costly regulations. Here’s the low-down on how those plans could affect your insurance choices.
Overcharging the healthy to undercharge the sick
Obamacare’s most significant change to the U.S. health care system was that it introduced an entirely new layer of federal regulations for individuals and families who buy their own health insurance directly, instead of getting it from their employer or from a government program like Medicare or Medicaid. Prior to 2014, these “individual market” or “nongroup” plans were regulated solely at the state level.
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A bipartisan group of governors working to strike compromise on hot-button policy issues will take on the health care question at an event Friday.
Republican Gov. John Kasich, of Ohio, Democratic Gov. John Hickenlooper, of Colorado, and Alaska Gov. Bill Walker, an independent, are among governors scheduled to headline a briefing at the National Press Club in Washington to discuss their latest ideas for improving the nation’s health care system.
Their blueprint, a copy of which was provided to The Associated Press, lays out a host of ideas for improving affordability, restoring stability, promoting flexibility so that states can innovate and eliminating duplicative and burdensome insurance regulations.
The governors urge the federal government to restore insurer subsidies that were stopped by Republican President Donald Trump, triggering sharp increases in premiums this year.
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On February 21, 2018, the District of Columbia (D.C.) moved one step closer toward becoming the second in the nation, behind Massachusetts, to adopt an individual health insurance mandate. The Executive Board of the D.C. Health Benefit Exchange Authority (Authority) approved a resolution recommending the adoption of a District-level mandate as well as a number of other policy proposals. The resolution will have to be approved by the D.C. Council before going into effect.
D.C. would be the first to adopt its own mandate in the wake of repeal of the Affordable Care Act’s (ACA’s) individual mandate, but it joins at least eight states considering or studying their own individual mandate.
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The Center for American Progress’s new “Medicare Extra for All” proposal is a repackaged version of the congressional Democrats’ 2009’s “public option” proposal. It imagines that large savings can be generated by extending Medicare’s price controls for hospital care, beyond the elderly and disabled, to the purchase of hospital care for other patients. Individuals and employers would be allowed to buy into the system, to take advantage of these discounted rates. Yet, the monopoly power which has inflated prices for hospital care provided to privately funded patients is a deliberate product of policy, intended to sustain the solvency of hospitals in counties across the United States, which would be unviable in a competitive market.
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Doug Badger, a senior fellow at the free-market Galen Institute, told LifeZette that the proposed rule change is the latest evidence that Trump is moving wherever possible to undo Obamacare restrictions on the health insurance market.
“I think the Trump administration is saying, ‘You know what? It’s probably better to have one of these short-term plans than none at all,’” said Badger, who also is a visiting scholar at the conservative Heritage Foundation.
Badger said the Obamacare changes reflected Obama’s philosophy of one-size-fits-all health care.
“They want people to be either uninsured or have Obamacare policies,” he said.
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