Category Archives: Medicare

Senator Heller’s Second Shot at Slashing Medicare and Medicaid

“This morning, the Senate Budget Committee will consider a resolution that instructs lawmakers to find ways to reduce Medicaid spending by $1 trillion (and Medicare spending by $473 billion) over the next decade, according to supporting documentation that Democrats are publicizing.” [WaPo]

Here’s the strategy: “A fast-track “reconciliation” process that would allow for tax cuts costing $1.5 trillion over ten years that require only a simple majority to pass.  The $1.5 trillion cost would not have to be offset by closing tax loopholes or ending unproductive tax breaks, and thus would add to the nation’s deficits, which are already growing as the baby boomers retire.  In addition, the resolution would allow the Senate Finance Committee to cut critical programs under its jurisdiction, including Medicaid, Medicare, and basic assistance for poor seniors and people with disabilities, and then use those savings to make the tax cuts even larger (so that the net cost of the tax cuts and the budget cuts combined equaled $1.5 trillion).  The reconciliation process is the same process that Congress tried to use to repeal the ACA and requires only a simple majority to enact law.”  [CBPP] (emphasis added)

And, there we have it: (1) If it’s a Republican budget, then adding to the federal deficit doesn’t matter; (2) in order to provide for tax cuts to the top 1% of income earners in the United States, the Committee can slash funding for Medicaid, Medicare, basic assistance for senior citizens, and people with disabilities.

The trick is that the Senate Republicans have to pass a “budget” slashing spending for those aforementioned Medicare and Medicaid beneficiaries, elderly people in poverty, and disabled people, in order to create ‘space’ for the “reforms” in their tax legislation.  The buck slashing needs to stop here.

Please contact Senator Dean Heller, and let him know that these are not Nevada priorities.

202-224-6244

702-388-6605

775-686-5770

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While We’re Ducking and Dodging

While we’re ducking, dodging, and otherwise attempting to avoid damage from the GOP, they’re still busy with legislation to make our lives just a bit more difficult.  Cases in point:

The House leadership has delayed, but hasn’t promised to discard, a bill, HR 367, to allow the general sale of silencers — which the proponents tell us will mitigate hearing loss for gun owners.  Pro Tip: A nice pair of headset style ear protectors will set you back about $30.00 (if the foamies will do you can buy’em for about 12 cents each in a bucket of 200) as opposed to spending $1300.00 on a suppressor for your AK/AR-some number or another.

The GOP tax cut legislation, which somehow is being titled “reform,” is a walloping giveaway to the top income earners in the U.S.  Not sure about this? See the Institute on Taxation and Economic Policy, that tells us those in the bottom 20% will see 1.3% of the tax benefits while the top 1% will enjoy 67.4%. Bringing this closer to home, the top 1% of income earners (which amounts to about 0.4% of our population) will get a 70.7% share of the tax cuts. For all that chatter about the Middle Class, the plan doesn’t really help middle class Nevadans:

“The middle fifth of households in Nevada, people who are literally the state’s “middle-class” would not fare as well. Despite being 20 percent of the population, this group would receive just 4.6 percent of the tax cuts that go to Nevada under the framework. In 2018 this group is projected to earn between $38,900 and $60,600. The framework would cut their taxes by an average of $380, which would increase their income by an average of 0.8 percent.”

Just to put this in context, a family in Nevada’s middle income range would see a tax cut of about $380…meanwhile back at the home mortgage, if that family is in Reno where the average home loan is about $187,000, the monthly payments are about $855 per month.  Congratulations Middle Class Nevadans, you may receive an annual prize of 44% of one month’s mortgage payment.  Color me unimpressed.

The GOP passed its version of the FY 2018 budget on a 219-206 vote.  Representative Mark Amodei (R-NV2) voted in favor of the bill; Representatives Kihuen, Titus, and Rosen were in Las Vegas attending to their constituents in the wake of the massacre at the music concert.   The AARP was quick to notice that the Republican plan calls for $473 BILLION to be cut from Medicare over the next 10 years.   Expect a cap on the Medicaid program funding; it wouldn’t be too far off to estimate cuts of about $1 TRILLION in that category.   Beware when Republicans speak of “entitlement reform,” that simply means cutting Social Security benefits and Medicare.  When they say “welfare reform,” they often mean cutting Food Stamps, Housing Assistance, and Medicaid.   Representative Amodei might want to explain why he supports cutting Medicare by $473 billion over the next decade?

Those in Nevada’s 2nd Congressional District can reach Representative Mark Amodei at 202-225-6155 (Washington DC) 775-686-5760 (Reno), or 775-777-7705 (Elko);  the office addresses are — 332 Cannon Building, Washington, DC 20515; 5310 Kietzke Lane #103, Reno, NV 89511; 905 Railroad Street, Ste 104D, Elko, NV 89801.

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Rest and Repair: ACA and market stabilization

Senator Dean Heller (R-NV) might have wished for a kinder, gentler, headline from the Reno Gazette Journal, but he got this one: “After weeks of waffling, Heller votes ‘yes’ on failed ‘skinny repeal’ of Obamacare.”  Rest assured, he’s promised to work on health insurance reform as part of his duties on the Senate Finance Committee.   This would be as good a time as any for him to demonstrate his knowledge of the insurance sector.

Heller Plays the Bail Out Card: Game One 

Let’s track back a couple of paces in time to review how Senator Heller presented his ‘moderate’ credentials on economic concerns.  While Nevada was in the throes of the Great Recession brought on by the Wall Street Casino machinations, Senator Heller was touting his opposition to the Dodd-Frank Act to insert some common sense regulation of the banking industy, casting it as follows: “Heller mentioned he was the only member of the Nevada delegation to vote against the bank bailout. He called the Dodd-Frank bank regulation bill “cover for those who voted for the bank bailout.”  In short,  that “cover” was the regulation of some of the practices that caused the collapse of the investment banks in the United States.  Senator Heller calculated that the use of the phrase “bailout” would be sufficiently negative to thoroughly obscure his support for the deregulation of the banking sector and the Wall Street Casino players therein.  There’s little reason to doubt he’ll try this play again in 2018.

McConnell Tees Up the Bail Out Card: Game Two

After the “skinny bill” failed, Senate Majority Leader Mitch McConnell provided the framework for the next time Senator Heller might want to play the Bail Out card:

“Now, I think it’s appropriate to ask, what are their ideas? It’ll be interesting to see what they suggest as the way forward. For myself I can say — and I bet I’m pretty safe in saying for most on this side of the aisle — that bailing out insurance companies with no thought of any kind of reform is not something I want to be part of. And I suspect there are not many folks over here that are interested in that. But it’ll be interesting to see what they have in mind.”  (emphasis added)

If Senator Heller didn’t mind obfuscating the purpose of the Dodd Frank Act (by calling it a bail out), he’ll certainly not mind playing the same game with the attempts to improve our health insurance system.  It would be very tempting for him to try this play one more time to cover his opposition to the very proposals that would stabilize the individual health care insurance markets in this country.  For the record, I’m assuming that if a proposal helps an insurance corporation, then Senator Heller will be sure to call it a “bail out.”   Or, in the immortal words of President George W. Bush, “There’s an old saying in Tennessee—I know it’s in Texas, probably in Tennessee—that says, ‘Fool me once, shame on…shame on you. Fool me — you can’t get fooled again.’

Making Mountains from Mole Hills

There are justifiable questions about the stability of the individual health insurance market, but before we launch major proposals in this direction it’s important to note that for all the palaver about the collapse, demise, descent or whatever of the Affordable Care Act, that individual market has been stabilizing on its own.  The Kaiser Family Foundation released its report on this market:

“Large premium increases, typically granted by state regulators, in 2017 contributed to the improved financial performance, as insurers adjusted for a sicker-than-expected risk pool, the analysis finds. However, data on hospitalizations suggest that the risk pool was not getting progressively sicker as of 2017, supporting the notion that the large increases were necessary as a one-time market correction.

Slow growth in claims for medical expenses also played a role in insurers’ financial improvements, according to the analysis.”

So far so good, but there are issues to be faced.

“Although the analysis finds the market is stabilizing, it notes that ongoing uncertainty over payment of cost-sharing subsidies to insurers and enforcement of the individual mandate could lead insurers to leave the market or charge higher premiums in 2018.”

We can now safely assert that when Senator McConnell (and perhaps Senator Heller) speak of “bailing out” insurance companies they may be referring to proposals to provide more certainty to the insurance corporations that the administration will, in fact, make good on those promises to come through with cost-sharing subsidies.  That’s truly stretching the definition of a bail out, but it may prove a highly convenient hook on which to hang Republican rhetoric.

The previous post mentioned the Three R’s — risk adjustment, risk corridors, and reinsurance.  Here’s one proposal for the last on the list:

“Senator Kaine and Senator Tom Carper of Delaware on Wednesday introduced legislation to create a reinsurance program to help insurers offset the cost of covering older, less healthy customers. That type of program—which provides payments to insurers that enroll high-cost individuals—was originally part of Obamacare until it expired last year, and Republican legislators in Minnesota and Alaska have embraced the idea as a way to stabilize insurance markets in those states. “That’s something that should have some bipartisan appeal,” Kaine said. [Atlantic]

Reinsurance was in place until 2016 in order to ease any problems with corporations insuring a high number of risky policy holders, such as those with pre-existing medical conditions.  Re-establishing it would serve the same stabilization purposes today.   The Kaiser Family Foundation provides an explanation of risk adjustment and risk corridors which don’t require an MBA to understand. Neither of these constitute any form of “bail out.”

Conflation Projection 

Conflation is too often a vehicle for obfuscation.  For example, one of the Republican objections to the ACA continues to be the incantation: Socialized Medicine!  There’s no hint of socialized medicine in the ACA, it’s a full bore market based system of encouraging  affordable health insurance policies sold by PRIVATE companies to PRIVATE CONSUMERS for use to pay PRIVATE HEALTH CARE PROVIDERS.  However, this doesn’t prevent Republicans from speculating on the ulterior motives of Democratic advocates of expanding access to affordable health insurance policies.

“Soon, they’ll want a public option!” And, then they’ll want Single Payer…and there you have it Socialized Medicine.

Let’s stop here before the fog gets too thick, and explore other options for improving health care access in another post.

*Thanks to @Karoli and Mark Stufflebeam for suggestions and references. 

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The Moderate Heller Myth: Health Insurance Edition

Senator Dean Heller (R-NV) has cultivated his “moderate” image to the point that this adjective is attached to him with remarkable consistency — when if a person does even a perfunctory piece of research on his actual voting record what emerges is the model of a hard line conservative.  There is a pattern.  The Senator expresses “concerns” with a bill; then announces with ranging degrees of fanfare his opposition to a bill “in its current form,” then when the rubber grinds on the road surface the Senator votes along with the Republican leadership.

Why would anyone seriously believe he would support fixing the Affordable Care Act’s problems and not ultimately support what is now being called the “skinny repeal” version in the Senate based on the following voting record:

In 2007 then Representative Heller voted against the Medicare Prescription Drug Price Negotiation Act (HR 4).  Then on August 1, 2007 he voted against HR 3162, the State Children’s Health Insurance Program reauthorization.  The next day he voted against HR 734, the Prescription Drug Imports bill.  On March 5, 2008 he voted against HR 1424, the Mental Health Coverage bill.  Further into 2008 he voted “no” on HR 5501, the bill to fund programs fighting AIDS, Malaria, and Tuberculosis, and “no” again on the concurrence version of the bill in July.   If he had a ‘flash’ of moderation during this period it happened in the summer of 2008 when he voted in favor of HR 5613 (Medicaid extensions and changes), HR 6631 (Medicare), the latter including a vote to override the President’s veto.  By November 2009 he was back in full Conservative mode.

He voted against HR 3962 (Health Care and Insurance Law amendments) on November 8, 2009, and HR 3961 (Revising Medicare Physician Fee Schedules and re-establishing PAYGO) on November 19, 2009.

In March 2010 Heller voted against HR 4872 (Health Care Reconciliation Act), and HR 3590 (Patient Protection and Affordable Care Act).  He also voted against the concurrence bills.

January 19, 2011 he voted in favor of the Repealing the Health Care bill (HR 2).  He also signaled his stance on Planned Parenthood when he voted in favor of H.Amdt. 95 (Prohibiting the use of Federal funds for Planned Parenthood) on February 18, 2011.    He was in favor of repealing the individual mandate (HR 4), of repealing the Prevention and Public Health Fund (HR 1217).  May 4, 2011 he voted to repeal funding of the construction of school based health centers (HR 1214).

There was another “soft” period in some of his initial Senate votes in 2011, especially concerning the importation of medication from Canada (interesting since many prescription drugs are manufactured in other overseas sites).  See S. Amdt 769, S. Amdt 2111, and S. Amdt 2107 in May 2012.  On March 31, 2014 he voted in favor of HR 4302 (Protecting Access to Medicare).

He was back riding the Republican rails in September 2015, supporting an amendment to defund Planned Parenthood, (S. Amdt 2669) which failed a cloture vote.   Then on December 3, 2015 he voted in favor of another ACA repeal bill (HR 3762).    If we’re looking for patterns in this record they aren’t too difficult to discern. (1) Senator Heller can be relied upon to vote in favor of any legislation which deprives Planned Parenthood of funding for health care services, (2) Senator Heller can be relied upon to vote in favor of repealing the Affordable Care Act, and (3) Senator Heller’s voting record, if it illustrates any ‘moderation’ at all, comes in the form of dealing with prescription drug prices, but even that is a mixed bag of votes.

Thus, when he makes comments like the following:

“Obamacare isn’t the answer, but doing nothing to try to solve the problems it has created isn’t the answer either,” the statement read. “That is why I will vote to move forward and give us a chance to address the unworkable aspects of the law that have left many Nevadans — particularly those living in rural areas — with dwindling or no choices.

“Whether it’s my ideas to protect Nevadans who depend on Medicaid or the Graham-Cassidy proposal that empowers states and repeals the individual and employer mandates, there are commonsense solutions that could improve our health care system and today’s vote gives us the opportunity to fight for them. If the final product isn’t improved for the state of Nevada, then I will not vote for it; if it is improved, I will support it.”

We should examine them with some caution.   If he is referring to rural Nevada voters as ‘victims’ of the Affordable Care Act he might want to note that before the ACA there was one insurer in the northern Nevada rural market and if there is only one now that’s really not much of a change, much less a “nightmare.”  Nor is he mentioning that the proposed cuts to Medicaid will have a profoundly negative effect on rural Nevada hospitals. [DB previous]

That Graham-Cassidy proposal isn’t exactly a winner either:

“The new plan released Thursday morning and written by Republican Sens. Lindsey Graham (S.C.) and Bill Cassidy (La.) would block grant about $500 billion of federal spending to the states over 10 years to either repeal, repair or keep their ObamaCare programs.”

We have no idea if the number is an accurate estimate of what would keep the health care systems of all 50 states afloat — no one seems to want to ‘score’ anything these days.  Additionally, Americans should be aware by now that when Republicans chant “Block Grant” they mean “dump it on the states, wash our hands, and walk away” while the states struggle to keep up with demands to meet needs and provide services, operating on budgets which cannot function on deficits.

Then, there’s that perfectly typical Hellerian comment: “If it is improved, I will support it,” leaving the issue entirely up to Senator Heller’s subjective assessment if “it” has improved his re-election chances enough to go along with it while not upsetting his very conservative base.  Meanwhile, the media persists in repeating the “Moderate Heller” mythology, and we haven’t even begun to speak of his actions to thwart and later repeal any common sense regulations on the financial sector.

 

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Filed under conservatism, Health Care, health insurance, Heller, Medicaid, Medicare, Nevada Test Site, Politics, public health, Republicans, Rural Nevada, SCHIP

It Ain’t Over Until The Fat Golfer Sings

Senator McConnell’s Secret Health Insurance Shop is still working, with the Lobbyists/Elves seeking a way to offer goodies acceptable to the wavering and the wanton.  Keep calling!  and if you’d like more information to substantiate your comments there are some excellent sources.

Kaiser Family Foundation:   Your one stop center for research and analysis on health insurance issues.  Definitely a “bookmark this” recommendation.  Today, KFF notes that before the implementation of the ACA individual insurance plans for health care did not cover delivery and maternity care  in 75% of the policies; 45% of the policies didn’t cover substance abuse treatment; and 38% failed to cover any mental health care services.

If terms like “risk adjustment,” “re-insurance,” and “risk corridors” seem like something written in Minoan Linear A, the KFF has an excellent summation of these technical terms in easily understood American English.

There are also some analytical pieces on the impact of Republican suggestions for health care insurance “reform” as they relate to rural health care in the following:

Human Rights Watch — Senate Health Care Bill A Swipe At Rural United States.

MSNBC/Scarborough – Rural Health Care Would Be Savaged By This Bill.

There’s a narrative going around that Democrats haven’t brought anything to the table, which depends on whether we’re taking the long or short term view.  In the short term this would be true — because the McConnell Secret Health Insurance Shop didn’t invite any Democratic participation,  for that matter there seems to have been some Republican Senators who were left in darkness.  The longer view would note some of the following:

Senator Franken’s “Rural Health Care Quality Improvement Act of 2016” (pdf) S. 3191 (114th Congress) was introduced in July 2016 and “died” in the Senate Finance Committee.  The bill would have amended two titles of the Social Security Act to improve health care in rural areas of the United States.

There is Representative Jan Shakowsky’s CHOICE Act, H.R. 635, which would establish a public option under the ACA.  See also S. 194, Senator Sheldon Whitehouse’s CHOICE Act.  There’s Rep. Gene Green’s HR 2628 to stabilize Medicaid and the Children’s Insurance program.  Rep. John Conyers introduced his form of “single payer” in his Medicare for All bill, HR 676.  On the topic of making pharmaceuticals more affordable:  Senator Sanders – Affordable and Safe Prescription Drug Importation Act S. 469.  Senator Klobuchar has a bill “… to allow for expedited approval of generic prescription drugs and temporary importation of prescription drugs in the case of noncompetitive drug markets and drug shortages.” S. 183. Rep. Kurt Schrader introduced H.R. 749 to increase competition in the pharmaceutical industry.  Senator Ron Wyden introduced S. 1347, RxCap Act of 2017.

Senator Klobuchar has also introduce a bill supporting Alzheimer’s caregivers in S.311.  Rep. Derek Kilmer’s bill, H.R. 1253, seeks to improve access to treatment for mental health and substance abuse issues.   This is by NO means an exhaustive list of what can be gleaned from Gov.Track, but it does illustrate that the Democrats are not without suggestions — negotiating drug prices for Medicare, stabilizing the current system, public options, single payer — it’s just that these bills won’t get out of Republican controlled committees and they didn’t make it into Senator McConnell’s Secret Shop.

Indulge in no victory dance, we’ve seen this movie before … don’t believe that some minor blandishment won’t be enough to lure Senator Heller from his current position …don’t think that the products of McConnell’s Secret Shop have stopped coming off their assembly line.

Senator Heller can be reached at 202-224-6224;  702-388-6605;  775-686-5770

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Filed under Health Care, health insurance, Medicaid, Medicare, nevada health, Pharmaceuticals, Politics, public health

All Quiet on the Humboldt

When last we heard from Rep. Mark Amodei (R-NV2) it was in early May at which time he smoothly flipped his vote on the disastrous ACA replacement bill, with a convoluted explanation that “it” wouldn’t hurt Nevada…and then came the CBO scoring.  The District 2 Congressional representative has kept his head down like a ground squirrel in his burrow by the side of the highway.  This prevents him from dashing into the roadway, or as constituents might call it — holding an in person town hall meeting.

Tossing statistics about like so much confetti doesn’t remove the cold fact that the bill for which Amodei voted cuts $839 Billion with a B from the Medicaid expansion.  Cue the GOP lament that there are “able bodied” people who benefit from the Medicaid program, a program initially meant to serve the desperately poor.  The expansion aided people who may not be homeless without a tent but who were certainly desperate in terms of their ability to afford health insurance for themselves and their families.  These are the people who waited until the medical situation was so dire expensive emergency room treatment was required; who used the emergency rooms as a form of walk in clinic for the lack of any more available alternative; who went without any medical attention whatsoever — 48,000 who died according to the Harvard study because health insurance was unaffordable.

Representative Amodei may not have believed the ACA replacement bill would have profound impacts on Rural health services, but other politicians from other states have pointed this out with remarkable clarity.

Missouri, for example, refused the Medicaid expansion, and the results aren’t positive, as described by Missouri Senator Claire McCaskill:

“Well, we have, first, more than 2 million Missourians live in rural areas of our state. And 41 percent of our state’s hospitals are in rural areas. We know that they are under particular stress right now, particularly in states like Missouri that have refused the money that has been offered them for their Medicaid program under the Affordable Care Act. We know that there’ve been 78 rural hospitals closed, including three in Missouri. We know that 74 percent of those hospitals were actually in states that refused to accept the Medicaid money that was offered by the federal government back to the federal taxpayers in those states.”

Arkansas which accepted the Medicaid expansion also has some issues related to its rural hospitals:

“The ACA’s crafters essentially made a deal with hospitals: The ACA cut Medicare reimbursements, but the reduction in uncompensated care through the Medicaid expansion helped offset some of those cuts. Without that offsetting boost, some of the state’s smaller rural hospitals might not be able to survive. A hospital like Baxter — the fifth most Medicare-reliant hospital in the nation, according to Moody’s, thanks to the community’s significant proportion of retirees — would be forced to make dramatic cuts in services without the Medicaid offset. “The expansion of Medicaid through Arkansas Works is one of the key components that’s been able to help us through the change in the ACA,” Peterson said. “Not just Baxter, but it helps all of rural Arkansas.”

What is true of Missouri and Arkansas is true for rural health care in general:

Of the more than 11 million people who have gained Medicaid coverage through the ACA expansion, nearly 1.7 million live in rural America, according to new CBPP estimates (see Appendix Table 1).  The expansion population is more rural than the population as a whole: rural residents make up 12.1 percent of the population of expansion states but 14.1 percent of expansion enrollees in these states.  In at least eight expansion states, more than one-third of expansion enrollees live in rural areas: Alaska, Arkansas, Iowa, Kentucky, Montana, New Hampshire, New Mexico, and West Virginia.

The Medicaid expansion has been a lifeline for rural areas in other ways.  The ACA coverage expansions, especially the Medicaid expansion, have substantially reduced hospital uncompensated care costs: uncompensated care costs as a share of hospital operating budgets fell by about half between 2013 and 2015 in expansion states.[8] Reductions in uncompensated care and increases in the share of patients covered by Medicaid have been especially important for rural hospitals.

Nevada hasn’t been immune from the problems associated with a lack of access to affordable health insurance and uncompensated care:

“Rural residents are themselves a public health challenge, as they are generally older, more isolated and less likely to be covered by insurance than their urban counterparts. They’re also more likely to smoke, suffer from obesity and hypertension and die from complications of diabetes.

But preventive care that could head off medical emergencies is hard to come by in many areas. Nevada’s rural and “frontier” counties – a term used for the state’s most-remote and sparsely populated regions – and reservations face severe shortages not just of doctors and primary care services, but also nurses, EMTs, dentists and substance abuse and mental health professionals. And in some areas, the numbers are dwindling, despite efforts to reverse the trend.”

 

And so, there are rural hospitals in Representative Amodei’s district — Elko, Lovelock, Battle Mountain, Yerington, Winnemucca, Ely, Fallon and others — wondering what effects will be felt if the GOP adopts the framework in the House bill for which Amodei voted.   Residents in Tonopah watched as their hospital closed in August 2015, an unfortunate testament to the perils of privatization.  The question which might, and should be raised, to Representative Amodei in some town hall (should he ever emerge) is how does the Republican version of health care insurance “reform” protect rural hospitals from financial pressures endangering rural hospital administration.

Ah, but all this is “old news” now that the Representatives voted on an unscored bill in their haste to get something, anything, done and have tossed the blazing ball into the lap of the Senate — in which we might expect Senator Dean Heller to lament the inadequacies of the measure to the Heavens, and then vote along with Senate leadership for the final (probably dismal) result.

Let’s guess that Senator Heller will announce his ‘profound misgivings and questions’ and then after consultations with some officials, reverse his position and do what he has always done — vote against any augmentation of health insurance affordability for his constituents (see his votes on SCHIP on multiple occasions.)

And so it remains — all quiet on the Humboldt — as Representative Amodei and Senator remain quiet (unless we count Heller’s scripted telephone town hall) on an issue of profound significance to District 2’s health care service providers.

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Medicare Fraud and the Public Images

Loretta Lynch

You go! Attorney General Loretta Lynch’s announcement about Medicare fraud prosecutions isn’t getting the play accorded to more “hot topic” issues, but it’s an important step in doing two things – actually getting fraud out of the Medicare system; and, two dispelling the GOP inference that fraud in social and health care systems is something done by imaginary welfare queens and ne’er do wells.

Who’s getting prosecuted?

U.S. law enforcement officials have charged 301 suspects with trying to defraud Medicare and other federal insurance programs in 2016, marking the “largest takedown” involving health care fraud allegations, the Justice Department said on Wednesday.

The national sweep resulted in charges against doctors, nurses, pharmacists and physical therapists accused of fraud that cost the government $900 million, the department said. The cases involved an array of charges, including conspiracy to commit health care fraud, money laundering and violations of an anti-kickback law. [NatMemo] (emphasis added)

That gives us a general idea that no, the fraudsters weren’t those so often maligned by conservatives as the “undeserving” poor who take advantage of “sacred tax dollars.”  These are professionals, presumably unwilling to settle for professional earnings, income derived professionally.  We can get a bit more specific.

“One group of defendants controlled a network of clinics in Brooklyn that they filled with patients through bribes and kickbacks.  These patients then received medically unnecessary treatment, for which the clinic received over $38 million from Medicare and Medicaid – money that the conspirators subsequently laundered through more than 15 shell companies.” [Lynch DoJ]

How many “undeserving poor” launder money through 15+ shell corporations?

Detroit clinic billed Medicare for more than $36 million, even though it was actually a front for a narcotics diversion scheme.” [Lynch DoJ]

“…another defendant took advantage of his position in a state agency in Georgia by accepting bribes and recommending the approval of unqualified health providers.” [Lynch DoJ]

Lovely.  Another Department of Justice public statement offers a few more details.

“According to court documents, the defendants participated in alleged schemes to submit claims to Medicare and Medicaid for treatments that were medically unnecessary and often never provided.  In many cases, patient recruiters, Medicare beneficiaries and other co-conspirators allegedly were paid cash kickbacks in return for supplying beneficiary information to providers, so that the providers could then submit fraudulent bills to Medicare for services that were medically unnecessary or never performed.  Collectively, the doctors, nurses, licensed medical professionals, health care company owners and others charged are accused of conspiring to submit a total of approximately $712 million in fraudulent billing.”  [HCFU DoJ]

What’s been the nature of the Congressional interest in the Health Care Fraud Unit’s efforts?  In 2013 it was to cut funding for Medicare and Medicaid fraud prosecution efforts. [CNBC] [WaPo] We might also want to remember that any additional mandatory funding beyond 2013 levels did not start  until 2015. [HHS]

The notion that “waste, fraud, and abuse” are associated with government employees and the undeserving – is directly challenged by the efforts of the Departments of Health and Human Services and the Department of Justice, and their findings that the fraudsters are among the professional civilian population – ready and willing to line their own pockets with tax dollars.

But don’t necessarily trust me, listen to the Inspector General:

“Health care fraud drives up health care costs, wastes taxpayer money, undermines the Medicare and Medicaid programs, and endangers program beneficiaries,” said Inspector General Levinson.  “Today’s takedown includes perpetrators of prescription drug fraud, home health care fraud, and personal care services fraud, three particularly harmful types of fraud plaguing our health care system.  This record-setting takedown sends a message to would-be perpetrators that health care fraud is a risky way to line your pockets.  Our agents and our law enforcement partners stand ready to protect these vital programs and ensure that those who would steal from federal health care programs ultimately pay for their crimes.” [DoJ]

Health care fraud investigators and prosecutors should be among the nation’s heroes, not castigated as ‘gum’int bureaucrats,’ and should have budget and resource support commensurate with the importance of what they are trying to accomplish.

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