After months of waiting, the decision on the health care law is finally at hand. What will happen if Obamacare gets past the Supreme Court and the Medicaid expansion takes place according to plan? Speculation has focused on the individual mandate, but requiring us to bow to turning Medicaid into the president’s public option is at least as damaging as forcing Americans to purchase insurance using the excuse that we need to reign in health care costs. Health care entitlement programs are already driving us to bankruptcy, and neither states nor the Federal Government can afford the cost of Washington’s inability to deal with their rising costs, which are fed by unsolvable problems like improper payments, and Medicare and Medicaid fraud.
The worst thing about the health care law is that it puts health care costs in the hands of federal and state governments that have proved time and again to be incapable of controlling the expense of administering massive programs and out of control bureaucracy. Health & Human Services paints a rosy picture of the agency’s role in implementing Obamacare:
… HHS will seek to drive down costs, put more money in the hands of the American people, and ensure all Americans receive the health care services they need and deserve.¹
Seek to is not the same as doing. Health & Human Services controls over $850 billion in spending.² Efforts to stem improper payments and fraud in entitlement programs have been losers as the size and scope of federal handouts spiral out of control while our ability to pay deteriorates with the economy. Last month, as the decision on the health care law crept closer, a Government Accountability Office report on Medicare and Medicaid costs noted that:
Open recommendations that could yield billions of dollars in savings remain in many areas . . .³
We heard the same thing last year:
The amount of improper payments creates urgency for CMS to effectively implement prior GAO recommendations, provisions in recently enacted laws, and recent guidance related to five key strategies to help reduce fraud, waste, abuse, and improper payments in Medicare and Medicaid.4
We were even hearing it thirty-five years ago, when problems were found with Medicaid fraud investigations:
About half of the fraud cases have been prosecuted, usually successfully, but there was often delay or unwillingness to prosecute. The States are responsible for Medicaid investigations, and Federal action has been minimal.5
Our two largest health care entitlement programs have improper payment rates in excess of 8%. Health care costs are already an insurmountable problem for states like Illinois, which has been battling over the size of essential Medicaid cuts that were just signed into law. Under Barack Obama the Federal Government has become more adept than ever at pushing the costs of partisan policy onto state budgets which bear the weight of decisions on education, immigration, and other favorites (see: When Do We Cut States Loose Because of the Debt?).
Despite a morass of earlier legislation and anti-fraud initiatives, Medicaid fraud, improper payments, and rising health care costs for an expanding group of Americans under the health care law will be an opportunity to lose billions more to waste, and will be a feast for those intent on committing fraud. State budgets will be saddled with more debt and taxpayers will be held against the wall to pay for Medicaid’s expansion at two levels of government.
The individual mandate is a thorn in the side of Americans not favorably disposed to being told how to spend their money, but Obamacare’s spending on Medicaid could hit our wallets a lot harder, especially as the federal contribution for states declines. Two things we know for certain. Costs we are already unable to bear are going to go up as health care entitlement programs compensate for an ongoing bad economy, and Medicaid fraud will increase as the program swells, another cost of how our government does business.
So where do we go in lieu of the Supreme Court tearing the heart out of the health care law? Republican lawmakers have promised to dismantle the bill. If only their Democratic opponents had remembered the first rule of medicine before they forced this one down our throats, at all costs do no harm.