Because states run programs like Medicaid, but the federal government pays for over half of it, states have the incentive to come up with new programs and less incentive to properly police Medicaid spending.
“state and federal prosecutors have been trying to bust fraudulent preschools and other Medicaid fraud schemes in Minnesota for more than a decade. And yet, there are always more. Law enforcement is doing its best, but the problem seems to be that the state’s welfare bureaucracy is doing a terrible job of stopping the scammers in the first place.
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This is not just a problem in Minnesota either. Medicaid fraud is remarkably common. The federal departments of Justice and Health and Human Services run a joint program to catch fraudsters, and in 2024 alone it accounted for 1,151 convictions that recovered almost $1.4 billion.
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Anyone who wants to stop Medicaid fraud should focus less on scoring partisan political points or demonizing immigrants and more on the boring work of fixing federal policy.
Telling states to pay for a larger share of their own Medicaid spending seems like an obvious step in the right direction. It would give state officials—from governors like Walz all the way down to the lowest-ranking bureaucrat—a stronger incentive to prevent waste and fraud in the first place. It would reduce the burden placed on out-of-state taxpayers when states with lax enforcement allow fraud like this to occur.”
“After a few months in the program, Smith was no longer diabetic, and she has now been sober for two and a half years.
Her story highlights the success of the Healthy Opportunities Pilot, which launched in North Carolina in March 2022. The program had benefits beyond health and quality-of-life improvements; researchers at UNC-Chapel Hill found the program saved $1,020 a year per recipient on health care costs, and the 38,000 participants had “significantly lower” emergency room visits than their peers.
The program was unique, funded with a five-year, $650 million federal grant approved by the first Donald Trump administration. The idea was to use fresh food, safe housing and transportation — social and economic factors that researchers say determine 80 percent of a person’s health — to improve the lives of the sickest, most expensive patients.
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But the Healthy Opportunities Pilot shows the limits of such food-based interventions in public policy. These programs often require longer-term investments, chafing against the cost-cutting instincts that characterize Trump’s second term and legislatures in most red states — the policy level at which most MAHA ideas are put into practice.
In the case of HOP, the Joe Biden administration approved a Medicaid waiver last December to continue the program in North Carolina, which Gov. Josh Stein, a Democrat, hoped to expand throughout the state over the next two years. But in June, the Republican-led state legislature declined to fund it. State lawmakers argue the program costs more than it saves — a claim that state policy experts dispute because of the way Republican lawmakers were calculating the numbers. These experts say the long-term savings potential was given short shrift.”
“The sum of statistical lives saved vastly exceeds the number of actual lives.
Think of all the things that have saved your life. Every breath you take, every heartbeat, every car and lightning bolt that didn’t hit you. Yet, you’re only alive once. Even if we restrict ourselves to the effects of government programs, the total statistical lives saved by all programs is far greater than the population.
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Wyse and Meyer only show one side of the ledger—the reduction in mortality among people who gain Medicare eligibility. On the other side are the statistical lives lost from the people the money is taken from, or the programs cut.
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Counting statistical lives saved or lost is a debased currency, because it counts each actual life multiple times. And citing only the good side of the ledger makes it impossible to evaluate.
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after the Medicaid expansion, total expenditures increased by more than $1 trillion. That spending also costs statistical lives
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the money could have remained in taxpayers’ bank accounts, which also could promote good health. Mortality declines with income. Even if the Medicaid expansion were a cost-effective way to improve mortality, you have to consider the other side of the ledger.
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The lifesaving medical measures with the biggest impact, such as vaccinations and antibiotics, are relatively cheap. The Medicaid expansion may have relieved financial stress and made the program’s beneficiaries more physically comfortable, which are better criteria for evaluating its impact.
Now consider the 2013 NEJM study trumpeted by conservatives, which examined various health measures. It found that Medicaid enrollment resulted in large and statistically significant improvements in patients’ subjective estimates of their health and quality of life, as well as significant reductions in their financial stress. But it did not find a statistically significant impact on mortality.
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The two studies are more valuable in combination than individually. The NEJM study had the advantage of random assignment and detailed individual data. The NBER paper had a much larger sample size and time interval. Both found significant benefits to Medicaid recipients, although they did not establish that these benefits were any greater than could have been obtained by simply giving each recipient several thousand dollars per year. Neither study convincingly answered whether Medicaid improved health or saved statistical lives.”
Work requirements on Medicaid will rob many people of health insurance because many will fail to do the burdensome paperwork to prove they are working.
Doctor has seen people die from preventable ailments because the people couldn’t afford to get care.
“Most Medicaid recipients (92 percent) under the age of 65 already work full- or part-time jobs, according to KFF.”
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“States have attempted to implement work requirements for their Medicaid programs, but have faced challenges to successful implementation. In 2018, when Arkansas attempted to implement similar Medicaid work requirements, confusion with paperwork resulted in 18,000 people losing health care, and there was no improvement in employment rates. Georgia’s work requirement program, which began in 2023, spent $55 million verifying eligibility. It enrolled only 2.3 percent of the estimated 240,000 Georgians who were eligible for the program.”
“As Republicans began to consider their bill in January, Trump promised to “love and cherish” Medicaid. But he ultimately embraced the cuts as necessary to get the bill passed and lobbied reluctant GOP representatives and senators to go along.”
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“Other entitlements like Medicare and Social Security, which both serve elderly people, were deemed too politically risky to touch. Trump has been even more adamant about not reducing benefits in Medicare and Social Security, a cornerstone of his first campaign in 2016, than he was about Medicaid.”
Trump’s big beautiful bill hits Medicaid hard, which provides health insurance for low-income people. The bill adds onerous paperwork requirements that many people will fail to complete. Republicans represent the cuts as getting able-bodied young men back to work, but for Medicaid to save money, it has to no longer pay medical bills, which do not primarily come from able-bodied young men.
“Tillis — who voted against the bill in a key procedural vote Saturday night and announced Sunday he would not run for reelection — delivered a scathing rebuke of the president’s agenda-setting bill in a Senate floor speech, explaining his position and pledging to withhold his vote unless his concerns about drastic cuts to Medicaid are addressed.
“What do I tell 663,000 people in two years or three years, when President Trump breaks his promise by pushing them off of Medicaid because the funding’s not there anymore, guys? I think the people in the White House … advising the president are not telling him that the effect of this bill is to break a promise,” Tillis said in his floor speech.”