Medicaid expansion hurts elderly, hearing witness says

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The House Energy and Commerce Subcommittee on Oversight and Investigations hearing on Tuesday.
The House Energy and Commerce Subcommittee on Oversight and Investigations hearing on Tuesday.

The expansion of Medicaid under the Affordable Care Act has negatively affected vulnerable beneficiaries such as the elderly, according to a witness testifying Tuesday at a House Energy and Commerce Subcommittee on Oversight and Investigations hearing with the stated goal of strengthening the Medicaid program.

Josh Archambault, a senior fellow at the conservative Foundation for Government Accountability think tank, recommended that Congress “immediately freeze enrollment in expansion states and not allow new states to expand. This would provide states with an opportunity to unwind their expansions and refocus existing resources on the most vulnerable.” Not all witnesses agreed with him, however.

Although the elderly are not included in the populations served under the expansion of Medicaid under the ACA, Archambault said, the elderly are affected because states receive an enhanced matching rate for spending related to those covered under the expansion but do not “for patients the Medicaid safety net was originally intended to protect — children, the elderly and individuals who are blind or disabled.”

“Lawmakers in all states — blue, purple, and red — are starting to realize the Pac-Man effect that Medicaid is having on their budget,” Archambault said. “Given the size of the Medicaid program, one of the only tools policymakers have to balance their budgets is to rein in Medicaid spending. But in order to save $1 in state Medicaid spending, states must make an average of just over $2 in total cuts to their traditional Medicaid programs.”

Archambault was one of several witnesses testifying at the hearing, which took place as some Democrats in the Senate boycotted the confirmation hearings for Health and Human Services secretary nominee Rep. Tom Price (R-GA), Treasury secretary nominee Steven Mnuchin, and attorney general nominee  Sen. Jeff Sessions (R-AL), causing the committees to lack the quorum needed to send the nominations for consideration by the whole Senate.

Ann Maxwell, assistant inspector general for evaluation and inspections in the Office of Inspector General of HHS, told subcommittee members that the Medicaid program could do more to prevent fraud by better screening providers, reducing the amount of improper payments made to providers or beneficiaries, improving the accuracy of claims data to make it easier to detect questionable billing practices, improving the accuracy of rosters of providers participating in managed care plans, and expanding the role of Medicaid Fraud Control Units to investigate abuse and neglect cases in home- and community-based settings.

Carolyn L. Yocom, director of healthcare in the Government Accountability Office, echoed Maxwell's points and noted previous work by her office to identify those “program integrity issues.” (See the links under “Related Articles,” below, for more information about OIG and GAO efforts.)

Witness Timothy M. Westmoreland, a law professor at Georgetown University who had been director of the Medicaid and Children's Health Insurance programs under President Bill Clinton, urged committee members not to use the existence of improper payments as “an excuse for cutting billions of dollars from states and for taking insurance from millions of people.”

“Not all of what is labeled ‘improper payments' are fraud or even mistaken,” he said. “Many are appropriate but simply badly documented (and may even be underpayments), and the actual loss to the government is much smaller than it may appear.” And HHS is addressing “the more serious problems of program integrity,” Westmoreland added.

The 32 states that have expanded Medicaid under the ACA “are making this part of the American insurance system sensible and fair for vulnerable people. Please do not turn back this response,” he said.

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