“First, it’s not as if there is some secret knowledge to be uncovered by the DOGE when it comes to fixing the rampant inefficiencies of the federal government. Those Medicare and Medicaid overpayments are documented annually, for example. The Government Accountability Office and various inspectors general file regular reports. The Congressional Budget Office maintains a list of things that could be cut to reduce the deficit. Various members of Congress—most prominently, Sen. Rand Paul (R–Ky.)—periodically publish lists of silly, wasteful, or dubious government spending.
What’s lacking, in short, is not ideas but the political will to act on them.
The amount of political will is going to matter, because that is very relevant to the second point: Unless Trump is willing to set aside his promise not to touch America’s entitlement programs, the DOGE will be unable to follow through on its mandate.
Again, look at those improper payments made by Medicare and Medicaid. The $101.4 billion of improper payments the two entitlements made in 2023 accounted for 40 percent of all improper payments across the entire government that year, according to the GAO. That same GAO report suggested a simple change in how Medicaid bills some of its services that, if implemented, could save $141 billion over 10 years.”
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“The same problem pops up when you start looking at other big swings that the DOGE could take. Seven of the top nine suggestions made by the Congressional Budget Office’s annual report on “options for reducing the deficit” involve changing elements of America’s three federal entitlement programs. Capping Medicaid spending, increasing premiums for Medicare Part B, or reconfiguring how Social Security benefits are paid to wealthier Americans each could save hundreds of billions of dollars over the next decade. None will be possible as long as entitlement reform is off the table.
All of this is a function of the federal government’s fiscal reality: Entitlements are the biggest and fastest-growing segment of the budget. This year, so-called “mandatory spending”—primarily Social Security, Medicare, and Medicaid, along with a few other government-funded health care programs—will cost nearly $4 trillion, while all discretionary spending will total less than $1.8 trillion.
Musk has promised $2 trillion in spending cuts, but he could propose eliminating all discretionary spending—good luck zeroing out the Pentagon—and would still fall short of that goal. It is impossible to be serious about fiscal reform while promising not to touch the entitlement programs.”
“What this allows the survey to demonstrate is that between 2002–2022—with the exceptions of 2004–2006 and 2013, in which no birthplaces were recorded—foreign-born respondents accounted for 18.6 percent less Medicare and Medicaid spending than their native-born counterparts. On average, this amounted to $1,775 per person in 2022 dollars, compared to $2,180 per person among those born in the U.S.
Bier breaks down the numbers even further to demonstrate that this trend holds across each year in the sample for which data was available: In 2022, the most recent year recorded, U.S.-born patients cost the health agencies $2,691 apiece, while foreign-born cost $2,116 each. The closest the two groups ever came to parity was in 2015, when the U.S.-born cost $2,312 and the foreign-born cost $2,233.
“Despite their lower incomes, immigrants are less likely to use publicly funded health care for several reasons,” Bier writes. “Most importantly, they are younger, but even controlling for age, immigrants tend to be healthier and participate in fewer high-risk activities. In addition, their eligibility for Medicare and Medicaid is more limited than for the US-born population….Finally, some eligible immigrants also do not enroll in these programs out of ignorance or fear about its immigration effects.””
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“The survey only notes a respondent’s birthplace, not their immigration status.”
“A GOP experiment forcing low-income people to work to qualify for public health insurance benefits is stumbling in Georgia.
The state’s Republican governor, Brian Kemp, expected 31,000 Georgians to sign up in the first year of the program, which started in July. Through four months, only 1,800 people enrolled — and critics blame the paltry expansion on an overly complex program with too many hurdles for people to clear.”
“In the six months since states began double-checking the eligibility of people enrolled in their Medicaid programs for the first time in three years, more than 8.5 million Americans have lost their Medicaid benefits.
Based on enrollment numbers at the start of the year, that means roughly 1 in 10 people covered by Medicaid have lost their health insurance in a matter of months. After the US saw its uninsured rate hit historic lows during the pandemic, millions of the most vulnerable Americans are now falling off the rolls — with no assurance they will be able to find another form of coverage.
Worse, many of those losing coverage are losing it because of administrative hiccups and would otherwise be eligible — a problem that is disproportionately impacting children.
We won’t know until next year’s national insurance surveys how many people simply ended up uninsured and how many people successfully enrolled in another form of health coverage even as they lost their Medicaid benefits. But it is safe to expect that millions more Americans are now uninsured than were at the beginning of the year.
The health effects of this massive loss in health insurance will take years to be realized. But we know that having Medicaid means people are more likely to see a doctor and keep up with managing chronic conditions. The program helps people live longer. So losing coverage will make it even more difficult for a population that already struggles with its health to stay well.
Here’s why this is happening: During the pandemic, Congress approved an emergency provision that prevented almost anyone from losing their Medicaid coverage. Even if you had a change in income or life circumstances that in normal times would have led to you leaving the program, you were allowed to stay as long as that emergency policy was in place. But that provision expired earlier this year, part of the government standing down from its pandemic footing, and states were tasked with double-checking the eligibility of every person who was on their Medicaid rolls — a process referred to as unwinding. Starting in April, they could remove people who they found were no longer eligible.”
“Hundreds of thousands of Americans lost their Medicaid benefits in April, as emergency pandemic provisions that kept people enrolled over the past few years began to end. The coverage losses are going to only grow.
In Florida, nearly 250,000 people lost Medicaid coverage in April, as states began a process to check whether everyone currently enrolled in Medicaid still meets the eligibility criteria. About 73,000 people were also deemed ineligible in Arkansas. Another 53,000 had their coverage terminated in Indiana and 40,000 were removed from Medicaid in Arizona.
Policy experts and advocates warned before the eligibility checks began that people who are still eligible for Medicaid could lose their insurance due to administrative problems, such as not receiving mail from the state or not returning documentation to confirm they are still eligible. Now the early evidence suggests that’s exactly what is happening.”
“There is a certain logic to Republicans’ commitment to pursuing Medicaid cuts: Social Security and Medicare are universal programs. Everyone pays in while they work, and then enjoys the benefits when they retire. Medicaid, on the other hand, is targeted to people who have low incomes. Republicans argue that this program, like food stamps and cash welfare, discourages people from seeking work, since they only qualify for benefits if their income is below a certain threshold.
“Assistance programs are supposed to be temporary, not permanent,” McCarthy said. “A hand up, not a handout. A bridge to independence, not a barrier.”
The problem is their diagnosis may be wrong. For starters, about two-thirds of the people covered by Medicaid — those who are children, elderly, or disabled — are usually exempted from work requirement proposals. Working-age adults who are expected to meet them can end up losing coverage even if they are attempting to satisfy it, if they have irregular work hours for example, or if they have trouble filing the necessary paperwork. One estimate of a Medicaid work requirement proposal in Michigan found that only about one-quarter of the people expected to lose their coverage were considered “out of work,” meaning they could work but weren’t. The rest were already working, retired, caring for a loved home at home, or unable to work for some other reason.
In Arkansas, where implementation of a work requirement was eventually blocked by a court order, nearly 17,000 people lost coverage after the requirement was put in place. Analyses later found that Medicaid beneficiaries had not started working more or earning more money as a result of the policy. Instead, lots of people got kicked off Medicaid, but it didn’t lead to an improvement in their economic status; they simply became uninsured.”
“Perhaps the greatest success of the American health care system these last few benighted years is this surprising fact: The uninsured rate has reached a historic low of about 8 percent.
That’s thanks in part to the pandemic — or, more precisely, the slew of emergency provisions that the government enacted in response to the Covid crisis.
One policy was likely the single largest factor. Over the past three years, under an emergency pandemic measure, states have stopped double-checking if people who are enrolled in Medicaid are still eligible for its coverage. If you were enrolled in Medicaid in March 2020, or if you became eligible at any point during the pandemic, you have remained eligible the entire time no matter what, even if your income later went up.
But in April, that will end — states will be re-checking every Medicaid enrollee’s eligibility, an enormous administrative undertaking that will put health insurance coverage for millions of Americans at risk.
The Biden administration estimates upward of 15 million people — one-sixth of the roughly 90 million Americans currently receiving Medicaid benefits — could lose coverage, a finding that independent analysts pretty much agree with. Those are coverage losses tantamount to a major economic downturn: By comparison, from 2007 to 2009, amid the worst economic downturn of most Americans’ lifetimes, an estimated 9 million Americans lost their insurance.”
High-Deductible Health Plans Reduce Health Care Cost And Utilization, Including Use Of Needed Preventive Services Rajender Agarwal et al. 10 2017. HealthAffairs. https://www.healthaffairs.org/doi/10.1377/hlthaff.2017.0610 Does High Cost-Sharing Slow the Long-term Growth Rate of Health Spending? Evidence from the States Molly Frean and Mark