Tag: medicaid

CBO: One-Year Delay of Employer Mandate Increases Spending, Debt, and Dependence

The Congressional Budget Office has released its cost estimate of the Obama administration’s one-year repeal delay of ObamaCare’s employer mandate and anti-fraud provisions. The CBO expects the Obama administration’s unilateral rewriting of federal law (my words, not CBO’s) will increase federal spending by $3 billion in 2014 and reduce federal revenues by a net $9 billion, thereby increasing the federal debt by $12 billion. If President Obama keeps this up, Congress may have to raise the debt ceiling or something.

Where is that $3 billion of new spending going? The CBO estimates the administration’s action will lead to about half a million additional people receiving government subsidies, including through ObamaCare’s Exchanges:

All told, as a result of the announced changes and new final rules, roughly 1 million fewer people are expected to be enrolled in employment-based coverage in 2014 than the number projected in CBO’s May 2013 baseline, primarily because of the one-year delay in penalties on employers. Of those who would otherwise have obtained employment-based coverage, roughly half will be uninsured and the others will obtain coverage through the exchanges or will enroll in Medicaid or the Children’s Health Insurance Program (CHIP), CBO and JCT estimate.

Which makes the president’s delay of the employer mandate and anti-fraud provisions consistent with his administration’s goal of hooking enough voters on government subsidies to affect electoral outcomes and votes in Congress.

You’ve Come a Long Way, Baby: Barack Obama on Health Care Fraud

Last week, President Obama approved a one-year, unilateral (and thus illegalrepeal of ObamaCare’s requirements that the federal government verify the incomes and insurance options of people applying for the law’s new subsidies—a move that eviscerated the law’s anti-fraud protections. Rescinding anti-fraud protections is nothing new (or defensible). There is a very powerful fraud lobby in Washington, D.C. Normally, such steps just mean an increase in fraudulent and improper payments from the federal treasury, and a few more ignored reports from the Government Accountability Office and HHS Inspector General. Obama’s move, however, is so sweeping that he effectively expanded the eligibility criteria for ObamaCare’s new entitlements without so much as consulting Congress. Indeed, the law Obama is implementing did not and could not have passed Congress.

Barack Obama wasn’t always part of the health-care fraud lobby. Oh, no: time was, he railed against health care fraud. When he pleaded for his health care plan before a joint session of Congress in 2009, he promised that with his plan:

We will root out the waste and fraud and abuse in our Medicare program that doesn’t make our seniors any healthier…I’ve appointed a proven and aggressive inspector general to ferret out any and all cases of waste and fraud.

Any and all cases! So inspiring. And in his final push for ObamaCare’s passage, he promised the law would reduce fraud and improper payments. Here are excerpts from a strident speech he gave in Missouri on March 10, 2010:

I believe that in everything government does, we’ve got a special responsibility to be wise stewards about how Americans’ hard-earned tax dollars are spent. And I know you agree with that, too. Doesn’t matter whether you’re a Democrat or a Republican, you don’t like seeing your money wasted — or an independent, don’t like seeing your money wasted.

That’s a responsibility my administration is seeking to fulfill every single day…

Washington is a place where tax dollars are often treated like Monopoly money — they’re bartered and traded, and they’re divvied up among lobbyists and special interests, and where waste — even billions of dollars of waste — is accepted as the price of doing business…

The health care system has billions of dollars that should go to patient care and they’re lost each and every year to fraud, to abuse, to massive subsidies that line the pockets of the insurance industry.

Let me just give you one example — this is a long recognized but long tolerated problem called “improper payments.” That’s what they call them. Washington always has a name for these things. “Improper payments.” And as is often the case in Washington, the more innocuous the name, the more worried you should be. So these are payments mostly made through Medicare and Medicaid that are sent to the wrong person, sent for the wrong reason, sent in the wrong amount. Sometimes they’re innocent errors. Sometimes they’re because nobody is bothering to check to see where the money is going and they’re abused by scam artists and fly-by-night operations…

If we created a “Department of Improper Payments” it would be one of the largest agencies in our government…

Now, for the past few years, there has actually been a pilot program that uses a system of tough audits to recover some of this lost money. And even though these audits, they were just operating mainly in three states, they already found a billion dollars in improper payments. So these results were both disturbing and encouraging. They’re disturbing because it shows you how much waste there is out there in the health care system. But it’s encouraging because we can do something about it.

So earlier today, with [U.S. Sen.] Claire [McCaskill, D-Mo.] looking over my shoulder — one of our auditors-in-chief — I signed an order calling on all federal agencies to launch these kinds of audits all across the country. All across the country. (Applause.) So agencies would hire auditors to scour the books, go through things line by line. Auditors are paid based on how many abuses or errors they uncover. So it’s a win-win. The auditor, if they do a good job they get a small percentage as a reward. And the taxpayer wins by getting huge sums of money that would otherwise be lost that we can then spend to provide care to people who really need it, or we can use to reduce the deficit.

Now, through this effort, we expect to more than double the amounts we would’ve otherwise recovered — a couple of billion dollars over the next few years. And I’m announcing my support for the Improper Payments Elimination and Recovery Act — that’s a mouthful — but this is a bipartisan bill — (applause) — is a bipartisan bill to expand our ability to do these audits, so we can prevent even more fraud and abuse and waste.

Now, the reason I’m bringing all this stuff up is because there’s been a lot of talk about health care lately. And look, I’ll be honest, a lot of people, they’re confused, they’re saying, well, how can you help people get insurance who don’t have it without it adding to our deficit? It’s a legitimate question.

Well, the reason is, is because so much of the money currently in our health care system is being misspent.

Barack Obama used to oppose health care fraud—up until the moment that opposing fraud conflicted with his goal of preserving ObamaCare.

And why not? It’s just other people’s money.

Delaying the Employer Mandate Requires Delaying All of Obamacare

The IRS has announced it will postpone the start date of Obamacare’s “employer mandate” from 2014 to 2015. Most of the reaction has focused on how this move is an implicit acknowledgement that Obamacare is harmful, cannot work, and will prove a liability for Democrats going into the November 2014 elections. The Washington Post called the decision a “fresh setback” and a “significant interruption” to the law’s implementation. John McDonough, a prominent supporter of the law, observes, “You’ve given the employer community a sense of confidence that maybe they can kill this. If I were an employer, I would smell blood in the water.” When a die-hard Obamacare supporter like Ezra Klein says the employer mandate should be repealed, clearly things are not going well.

While all of this is true, it misses the two most significant implications of this momentous development:

First, the IRS’s unilateral decision to delay the employer mandate is the latest indication that we do not live under a Rule of Law, but under a Rule of Rulers who write and rewrite laws at whim, without legitimate authority, and otherwise compel behavior to suit their ends. Congress gave neither the IRS nor the president any authority to delay the imposition of the Patient Protection and Affordable Care Act’s employer mandate. In the section of the law creating that mandate, Congress included several provisions indicating the mandate will take effect in 2014. In case those provisions were not clear enough, Section 4980H further clarifies:

(d) EFFECTIVE DATE.—The amendments made by this section shall apply to months beginning after December 31, 2013.

It is hard to see how the will of the people’s elected representatives – including President Obama, who signed that effective date into law – could have been expressed more clearly, or how it could be clearer that the IRS has no legitimate power to delay the mandate. Again, Ezra Klein: “This is a regulatory end-run of the legislative process. The law says the mandate goes into effect in 2014, but the administration has decided to give it until 2015 by simply refusing to enforce the penalties.”

(Unintentional) Praise for ‘50 Vetoes’

The Fiscal Times:

So far, officials in 34 states have elected not to create insurance exchanges under the law where the uninsured can go to purchase affordable or subsidized health care coverage. And only 20 states and the District of Columbia have agreed to expand Medicaid programs for the poor and disabled…

Earlier this year, Cannon published a lengthy Cato “white paper,” a handbook of sorts for gumming up the works. Entitled “50 Vetoes: How States Can Stop the Obama Health Care Law,” the report urges governors and state officials to refuse to set up insurance exchanges in their states and to refuse to opt into an expanded Medicaid program for the poor…

Ron Pollack, executive director of Families USA, and a board member of Enroll America, complained…that Cannon’s handbook was designed to “throw sand into the machinery of state implementation of the Affordable Care Act.”

“So has it been a factor? Of course,” added Pollack.

Click here to read “50 Vetoes.”

How to Tell If the Government Has Taken over Health Care

From the Washington Post:

Hedge fund executives and other investors are increasingly interested in the timing and nature of health-policy decisions in Washington because they directly affect the profits and stock prices of pharmaceutical, insurance, hospital and managed-care companies…

[Former Centers for Medicare & Medicaid Services] director Thomas Scully, who served during the Bush administration…said he thought that it was useful for CMS officials to have more communication with Wall Street investors as a way for regulators to learn and “explain what an $800-billion-a-year agency” does with its money.

So long as someone is still making a buck, it’s not socialized medicine…right?

NYT Room for Debate: the Oregon Medicaid Study & ObamaCare

Today’s New York Times Room for Debate” feature poses the question, “Do the mixed results of an Oregon health care study show that government medical insurance should provide only catastrophic coverage?” From my contribution:

ObamaCare aims to cover 16 million poor uninsured adults through Medicaid, plus 16 million higher-income uninsured Americans through government-subsidized “private” insurance. Supporters portrayed these “reforms” as a matter of life and death, particularly for the poor. Yet a monumental new study finds that “Medicaid coverage generated no significant improvements in measured physical health outcomes” for poor adults. These findings strengthen the case that states should stop implementing ObamaCare, and Congress should swiftly repeal it…

The absence of physical-health improvements indicts the entire enterprise. Supporters have an obligation to show that the $2 trillion in entitlements ObamaCare will launch next year would actually improve enrollees’ health. The Oregon study shows they cannot meet their burden of proof. What part of “no discernible improvement” don’t they understand?

Read the whole thing here. See also the contributions by Drew Altman, Austin Frakt, Robert Reich, and Grace-Marie Turner.

‘Why Indiana Shouldn’t Fall for Obamacare’s Medicaid Expansion’

My latest oped, in the Indy Star:

Meanwhile, many [Medicaid] enrollees can’t even find a doctor. One-third of primary care physicians won’t take new Medicaid patients. Only 20 percent of dentists accept Medicaid. In 2007, 12-year-old Deamonte Driver died — yes, died — because his mother couldn’t find one of those dentists.

For more on why states should reject ObamaCare’s Medicaid expansion, read my latest Cato white paper, “50 Vetoes: How States Can Stop the Obama Health Law.”