Posted on 05/21/2025 5:23:01 AM PDT by MtnClimber
As soon as Republicans mentioned cutting spending on Medicaid as part of their “reconciliation” bill, the usual suspects started rolling out their standard talking points. They’re cutting health care for the poor to pay for tax cuts for the rich! Millions will lose coverage! The disabled will suffer! Oh, the humanity!
Well, if the GOP is going to be accused of destroying Medicaid when all they are proposing is a minor haircut, why not go all out and scrap this hopelessly flawed, fraud-riddled, budget-busting disaster of a program and start over from scratch?
First, let’s dispense with the claim of “devastating” cuts to Medicaid. The House reconciliation bill would reduce Medicaid spending by $625 billion. That might sound like a lot, but it’s stretched out over 10 years, at a time when Medicaid is on track to spend $8.6 trillion. Medicaid spending will still go up every year under the House bill, just a tiny bit more slowly.
What Republicans should really be talking about is giving Medicaid the USAID treatment. Shut it down and start over from scratch.
Let’s line up the reasons.
It was sold on a lie. The original claim made in the mid-1960s was that the federal government and the states would split the cost of Medicaid. But that happened only once: in the program’s first year. Ever since, the federal share has grown while the states’ shares have shrunk. By 2005, states were paying only 42% of Medicaid’s bills. In 2022, the state share dipped below 30%.
Over the past 60 years, states have pressured federal lawmakers to make a multitude of exceptions to the 50-50 split, which lawmakers were only too happy to provide because there is no cap on federal Medicaid spending.
It is ripe for waste and fraud. This financing scheme, in turn, gives states little incentive to run their programs efficiently. Why should they? They are paying only a fraction of the costs. Plus, for every dollar of waste or fraud a state eliminates, it loses even more money from the feds.
“Official government reports conservatively estimate that improper Medicaid payments total half a trillion dollars over the last decade, but outside estimates place that figure closer to $1.1 trillion,” notes the Cato Institute’s Dominik Lett.
In other words, just cutting out waste and fraud would more than cover the “cuts” the GOP is proposing.
But that will never happen so long as states are paying pennies on the dollar for Medicaid.
States use Medicaid to steal federal money. On top of this, as we pointed out in this space earlier, states also figured out how to game the system through “provider taxes.” The way it works is that states impose a special tax on Medicaid providers, boost Medicaid reimbursement rates to cover the cost of the tax, and then send the bill to Congress. Congress has tried to rein in this abuse, but to no avail.
Back in 2011, when Joe Biden was vice president and more mentally capable, he called this a scam, said states were gaming the system, and said there was no reason for Congress not to stop it. The Congressional Budget Office says the 10-year cost of this one racket is $600 billion – almost exactly what the GOP wants to cut. (See “Dems Fight To Protect A $600 Billion Medicaid Tax Scam That Joe Biden Tried To Kill.”)
Spending is out of control. It should come as no surprise, then, that Medicaid spending is exploding. Over the past 10 years, Medicaid’s costs have gone up by more than 68%. They are on track to climb another 56% over the next 10 years.
The quality of care is lousy. Even with these massive costs, quality of care is far from optimal. A Kaiser Family Foundation survey finds that more than half of Medicaid enrollees say they’ve had a problem with their insurance in the past year, with 26% saying they couldn’t get recommended care and 22% saying they experienced “significant” delays in getting care.
An NIH study found that “Medicaid patients have greater difficulty obtaining appointments compared with privately insured patients across a variety of medical scenarios.” An article in Health Affairs found that far fewer doctors were accepting new Medicaid patients than either Medicare or privately insured ones.
The reason is that Medicaid pays doctors less than either Medicare or private insurance, and piles on mountains of paperwork.
Tweaking the program won’t solve any of these problems.
The only real solution is to scrap Medicaid and figure out a 21st-century solution to providing quality health care to the nation’s poor.
An obvious first step would be to get the federal government out of the picture entirely. Just send the Medicaid money to states in the form of a fixed block grant and let them figure out how to efficiently care for their poor.
Or better still, stop taking hundreds of billions of tax dollars out of states only to give the money back – minus federal overhead costs and with a multitude of strings added.
The left would scream bloody murder. But the only losers would be the legions of Medicaid grifters and fraudsters who are getting rich while pretending to care for the poor.
Click here: to donate by Credit Card
Or here: to donate by PayPal
Or by mail to: Free Republic, LLC - PO Box 9771 - Fresno, CA 93794
Thank you very much and God bless you.
But what about the Medicaid grifters and fraudsters? They will be hurt.
Waste of time talking about it. Medicaid won’t end unless an asteroid hits it.
And the thing nobody’s talking about, Medicare/Medicaid dual eligibles who have squirreled away their money in order to qualify...
It shouldn’t end.
But it should bloody well be reformed.
We would be spending 100% of our GDP on healthcare, were everyone to receive all the attention they want on platinum plans. The problem is too much government subsidy, not too little.
That said, the solution is to send more of it every year back to the states to let them deal with it. There is no way this should be a federal function—and it is a political loser to directly take away benefits the Dems have already doled out.
Isn’t there some crazy law whereby seniors can get Medicaid nursing home coverage while they still have up to $1M in assets (not counting the assets they might have sheltered previously).
I know someone on Medicaid who is working for cash and getting social security. She has better care than I do with Medicare and an insurance supplement. She had a major surgery and it cost her $20. I turned her in a year ago but she is still on it with no problems. How many millions are on Medicaid just like her?
Depends on the state, IIRC, exactly what the spend down is, assets you can retain.
I will say this.
We had a number of loved ones with dementia who required assisted living and/or skilled nursing.
All paid their own way. They could do that and refused to game the system.
For years I got to see the kind of care dual eligible residents got, and all I can say is this...
If you spend down, stash your cash with/for your kids, you’d better pray to God they love you. Because you will get the kind of care you pay for. And you will not like it.
Politics has nothing whatsoever to do with ideals. Politics is almost exclusively the art of the possible, and only when it combines to the advantage of those who practice it.
Very bad legislation gets passed, with some sort of expectation that maybe somebody in the future will get the moving parts to somehow mesh and at least some minimal social benefit will result.
In order to pull a rabbit out of a hat, first you must have a rabbit, then the hat is of course obligatory. But keep in mind, that it was all illusionary, the rabbit was never in the hat.
Medicaid serves a purpose.
But it should be a court of last resort.
I doubt it. My patients on medicaid may have still had a house if their spouse was living in it, but upon death it was liable to be taken and sold for reimbursement. Pre sheltering by transfer of title was possible if it happened five years before applying for medicaid. But who would think to do that.
Most people with over a million in assets, I’d think—unless their infirmity crept up on them.
I’d prefer my current coverage under my retirement health plan except I’m being forced off onto Medicaid when I hit 65. Not a happy camper.
“The only real solution is to scrap Medicaid and figure out a 21st-century solution to providing quality health care to the nation’s poor.”
Agreed
Basic Primary care should be low-cost and plentiful. A whole bunch of legitimate parties can provide decent basic care.
Even a Volunteer Ambulance Corps could do a whole bunch.
Advanced care and specialty care will always be expensive, and scarce.
Poor folks can’t get a new Lexus.
But there’s a whole bunch of cheap Bicyles.
Reality is what’s left even after you stop believing in it.
Ending Medicaid would be a great way to get rid of a lot of illegals and the elderly parents and grandparents.
Stop giving it to illegals - anywhere at anytime - as is done in California to the tune of $12B.
Funny how that is the exact amount of California’s budget deficit.
Trump will tell Newsom NO when he comes begging for federal dollars. If Newsom had a money printing press, he’d have no problem whipping up fake dollars to cover it all.
It is neither grift nor fraud to be paid (something) instead of being paid nothing to render care that is required by law.
I never meant to imply that payment for LEGITIMATE health care is grift or fraud. There needs to be a system devised that keeps the health care and gets rid of the grift and fraud by states like California that loot their Medicaid funds. What also needs to be drastically reduced is administrative requirements and expense placed on the healthcare industry.
The Medicaid asset test (and therefore the nursing home funding case) is pretty strict but does vary by state.
California appears to be the most generous.
Nearly all states have a look-back period for disposal of assets (to children or whoever). 5 yrs. If you drew down assets within 5 yrs of entering the nursing home then those assets are considered still yours and there will be no Medicaid coverage of Long Term care expenses.
People generally jump to talk nursing homes when cuts to Medicaid are discussed, but it’s useful to know that the average stay in a nursing home by elderly residents is only 14 months. They do not last long. So it’s not really a huge chunk of Medicaid expenses.
The big chunks are support of healthcare for children of single white mothers (often Appalachia). And disabled healthcare (which is not cheap).
There is a wish that big numbers can be found for the healthcare of illegals. There is no indication those expenditure numbers are big.
Disclaimer: Opinions posted on Free Republic are those of the individual posters and do not necessarily represent the opinion of Free Republic or its management. All materials posted herein are protected by copyright law and the exemption for fair use of copyrighted works.