Health care programs need closer look before ObamaCare expansion

Senator Sean Nienow
Guest Commentary

On June 28 the Patient Protection and Affordable Care Act (ObamaCare), including its individual mandate that virtually all Americans buy health insurance, was mostly upheld by the Supreme Court on a 5-4 vote. Unless and until repealed, ObamaCare is the law of the land.

A significant part of this federal law includes a very large expansion of Medicaid—subsidized health insurance for the poor —a program riddled with fraud. Over the last several years, allegations have been made that Minnesota inflated Medicaid spending figures in order to receive additional, unwarranted taxpayer dollars from the federal government. Congressional subcommittees of the House Oversight and Government Reform Committee held hearings regarding the lack of transparency, accountability and oversight of Medicaid funding in Minnesota and around the country. The final report from the hearings specifically cites Minnesota as an example of “how states are failing to properly ensure the appropriate use of taxpayer dollars spent”.  Also, a recent federal Government Accountability Office Report to Congress said that without corrective action in the program we “…continue to put billions of taxpayer dollars at risk of improper payments or waste.” With a massive expansion of Medicaid set to occur under ObamaCare, the time to take action on accountability and transparency is now, not later.

The enormous expansion of Medicaid underscores the grave urgency for audits of the MN Medicaid program administered under managed care (HMOs). The same HMO’s run both the Medicare and Medicaid programs, but historically Minnesota Medicare costs have been among the lowest in the nation while Medicaid costs are among the highest—even though Medicare is only for the elderly who typically use more health care and are more expensive to cover. On its face, something doesn’t look right there. We simply cannot expand Medicaid under ObamaCare without first auditing our system to get a true picture of what the legitimate cost should be. An expansion based on fraudulent or artificially inflated numbers would be an egregious waste of taxpayer dollars. We must get an accurate assessment of the current program before adding hundreds of thousands of people into Medicaid.

In Minnesota, Medicaid is run by just four HMOs. Current state law prohibits market competition from other HMO’s who would like to make a profit here, even though competition almost always lowers prices for the consumer. Expansion of Medicaid, if we are to avoid a cartel-like situation, must include opening Medicaid programs in our state to other HMO competitors.  Before Minnesota can move to a block grant system or any other appropriation from the federal government, we must have audits performed immediately or we must make our Medicaid payment rates default to the Medicare rate in MN where we have accuracy and accountability.

I’m glad to say I was able to enact a state law requiring audits of these programs, but due to budget constraints funding for that might not be available for an audit until 2015. I recently sent a letter to the federal Center for Medicaid and Medicare Services (CMS) requesting they conduct an immediate audit of Minnesota’s public health care programs and their funding. CMS can do this using the Medicaid Integrity Program included in the Social Security Act and expanded in the Patient Protection and Affordable Care Act. CMS has the resources to commence an audit this year. With the conclusions reported after the two Oversight Committee hearings, the need to take action is critical.

Since half of the Minnesota Medicaid program is paid for with federal tax dollars, the federal government has a clear financial interest in finding any waste or fraud as soon as possible. If CMS performs the audit now rather than waiting until Minnesota’s audit, the federal government will get an immediate account of the Medicaid spending in Minnesota. As an added benefit, Minnesota’s future audits will be less expensive. It’s a classic win-win. The Feds get the accountability needed to prevent fraud and abuse, the State saves time and money and the Taxpayers get the transparency in government they deserve. The best thing though—those “billions of taxpayer dollars at risk” probably won’t be so much at risk anymore, and that sure would be nice.

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