and abuse in Medicaid — or Obam- acare, for that matter. Why would they? They want as many people as possible in government-run healthcare. According to a December Gallup
poll, “90% of Democrats . . . now say the government should ensure health coverage for all.” So, what difference does it make if
millions of ineligible people are receiv- ing healthcare benefits? They’re get- ting government healthcare, which is the goal.
ing taxpayer-provided subsidies for coverage under Obamacare, and you can see liberals have made enormous progress in transitioning the country to government-run healthcare. Republicans are trying to reverse
that progress in the OBBB by remov- ing ineligible beneficiaries, attacking fraud, and eliminating perverse eco- nomic incentives.
HUGE FRAUD The U.S. Department of Health and Human Services Office of Inspector General (OIG) published a report in 2022 covering four states — New York, California, Colorado, and Kentucky — estimating the number of ineligible Medicaid beneficiaries in 2014 and 2015.
OIG found federal Medicaid pay-
ments for new beneficiaries “total- ing almost $1.4 billion for more than 700,000 ineligible or potentially ineli- gible beneficiaries.” For those who had been enrolled for
a while, OIG found Medicaid spent “$5 billion for almost 5 million ineligible or potentially ineligible beneficiaries.” Remember, that’s only four states. The Centers for Medicare and Medicaid Services (CMS) just released
a report announcing it had identified 2.8 million Americans enrolled in two or more of the government-sponsored health plans in multiple states. The report added, “CMS is taking
action to ensure individuals are only enrolled in one program and to stop the federal government from paying multiple times for these individuals to receive health coverage.” Not all ineligible beneficiaries are committing fraud. Some may take a job that provides health coverage, or their incomes rise above the limit, or they turn 65 and enroll in Medicare, or they move out of state and don’t notify Med- icaid. And, of course, some die. There can be honest mistakes. But Republicans want to get those who are ineligible for whatever reason off the rolls — including illegal immigrants. Democrats will assert Medicaid law
prohibits covering illegal immigrants. But we know that many illegal immi- grants use fake IDs or steal Social Secu- rity numbers, which might also allow them to enroll in Medicaid.
DEMOCRATS WON’T HELP Republicans will get no help from Dem- ocrats on this issue because Democrats don’t really care about waste, fraud,
WORK REQUIREMENT Perhaps the most offensive provision of the OBBB for Democrats is the work requirement. The law requires “able- bodied, working-age adults to engage in 80 hours of work, job training, edu- cation, or volunteering monthly to maintain Medicaid eligibility.” It’s not an onerous burden, and it specifically excludes disabled people and those in nursing homes. Democrats complain that a work requirement punishes the poor. How- ever, some 165 million U.S. workers and their dependents get their health insurance from their employers. That health coverage is a benefit for work- ing; it’s not punishment. So, what’s so outrageous about able-bodied people on Medicaid work- ing to receive health coverage? Democrats also complain that per-
haps 5 million people will lose their coverage because they can’t or won’t work. But workers with employer health coverage also lose their cover- age if they refuse to work. Why should able-bodied Medicaid beneficiaries be any different?
POLICING MEDICAID ROLLS Another way to ensure that only eli- gible people are in Medicaid is by frequently auditing states’ Medicaid populations. The OBBB requires states to “con-
duct eligibility redeterminations at least every six months — instead of annually — for Medicaid expansion adults.” Democrats opposed that provi-
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