Medicaid: Last Week Tonight with John Oliver (HBO)
Summary
TLDRThe video script discusses the challenges and issues within the Medicaid system in the United States. It highlights the 'Medicaid unwinding', where hundreds of thousands of Americans are losing their Medicaid coverage due to eligibility rechecks post-pandemic relief measures. The script criticizes the lack of innovation in healthcare administration, the complexity and inefficiency of the enrollment and renewal processes, and the moralizing tone of some state policies, such as work requirements for Medicaid eligibility. It also calls out the role of Managed Care Organizations (MCOs) in denying necessary care to prioritize cost savings. The speaker advocates for more efficient administration, better use of existing databases for eligibility, increased oversight of MCOs, and a push towards a universal healthcare model.
Takeaways
- 📉 Medicaid, a public insurance program for low-income individuals, has seen a significant drop in enrollment due to the 'Medicaid unwinding', leaving many without coverage.
- 🚫 The unwinding process has been characterized by people being removed from Medicaid without notice, leading to confusion and a lack of access to necessary healthcare.
- 📈 Medicaid covers a vast number of Americans, with over 90 million people enrolled at its peak, but the unwinding has reduced this number by over 11 million, including nearly 5 million children.
- 🔄 The unwinding was partly by design, stemming from a pandemic relief bill that initially prevented states from removing people from Medicaid but expired in March, leading states to reevaluate eligibility.
- 📝 Administrative issues, such as missing paperwork, have led to the termination of coverage for 69% of those who lost Medicaid, highlighting systemic flaws in the program's administration.
- 👶 Stories of families with children who have severe health conditions, like leukemia, being abruptly dropped from Medicaid illustrate the human impact of these administrative shortcomings.
- 💰 Medicaid is a joint federal-state program with significant state discretion, which can result in varying levels of care and accessibility across different states.
- 🤔 The script questions the moralizing tone of some state policies, such as work requirements for Medicaid eligibility, which may not align with the realities of most enrollees who are already working or unable to work due to disability or education.
- 🚫 Managed Care Organizations (MCOs), which oversee a large portion of Medicaid enrollees, have been criticized for denying necessary care to cut costs, prioritizing profits over patient health.
- 💔 Cases like Louis Fender's, who lost critical services after an MCO took over his care, exemplify the negative consequences of prioritizing cost savings over comprehensive healthcare.
- 📋 The script suggests improvements such as leveraging existing databases for eligibility checks, increasing oversight of MCOs, and ensuring Medicaid agencies have the resources to enforce compliance.
Q & A
What is the significance of Medicaid in the US healthcare system?
-Medicaid is a public insurance program that provides health coverage to people with low incomes. It represents one out of every six dollars spent on healthcare in the US and, as of last year, covered more than 90 million people.
What is the 'Medicaid unwinding'?
-The 'Medicaid unwinding' refers to the process where hundreds of thousands of Americans are being removed from Medicaid coverage, sometimes with no notice. This has led to a rapid decline in the number of people insured by Medicaid.
Why was there a surge in Medicaid enrollment during the pandemic?
-During the pandemic, an early relief bill included a requirement that states could not remove people from Medicaid. This was due to the global public health emergency and the fact that millions were losing jobs and getting sick.
How has the end of the public health emergency impacted Medicaid?
-The end of the public health emergency led to the expiration of the policy preventing states from checking Medicaid eligibility. This resulted in states starting to reevaluate individuals' eligibility for the first time in three years.
What are some of the administrative issues that Medicaid beneficiaries face?
-Administrative issues include navigating poorly designed websites, long wait times, complex forms and notices, and the need to renew coverage every year, which can be burdensome and lead to loss of coverage due to procedural reasons like missing paperwork.
What is the role of Managed Care Organizations (MCOs) in Medicaid?
-MCOs are private companies that states contract with to deliver and pay for healthcare. They oversee care plans for the majority of Medicaid beneficiaries. However, they are paid a fixed rate per person, which incentivizes them to cut costs at the expense of necessary care.
Why are some states implementing work requirements for Medicaid eligibility?
-Some states have implemented work requirements as a condition of Medicaid eligibility in an effort to promote the dignity of work and ensure that only those who are deemed to be contributing to society receive benefits. However, this approach has been controversial and faced legal challenges.
What are the consequences of losing Medicaid coverage for individuals?
-Losing Medicaid coverage can have severe consequences for individuals, particularly those with chronic health conditions or disabilities. It can lead to a lack of access to necessary medications, medical treatments, and preventive care, potentially resulting in more severe health outcomes and increased medical costs.
How does the Medicaid system vary from state to state?
-Medicaid is a partnership between the federal government and the states, which means that while there are some federal requirements, states have significant leeway in how they administer their programs. This leads to variations in eligibility criteria, coverage, and the services offered.
What are some of the larger issues with how Medicaid has been administered?
-Larger issues include the difficulty in accessing Medicaid due to administrative barriers, the variability in state administration leading to unequal access and quality of care, the implementation of work requirements, and the role of MCOs which may prioritize cost-cutting over patient care.
What steps could be taken to improve the Medicaid system?
-Improvements could include leveraging existing databases for eligibility determination, ensuring adequate federal oversight of state Medicaid programs, increasing transparency and public scrutiny of MCOs, and simplifying the application and renewal processes to reduce user errors and improve timely renewals.
Outlines
😀 Medicaid's Challenges and the Unwinding Process
The first paragraph discusses the lack of innovation in the healthcare industry, particularly concerning Medicaid, a public insurance program for low-income individuals. It highlights the massive scale of Medicaid, covering over 90 million people, or roughly one out of every six dollars spent on healthcare in the US. However, due to the 'Medicaid unwinding', hundreds of thousands are losing their coverage, sometimes without notice. The unwinding began as a policy response to the pandemic, preventing states from removing people from Medicaid, but this policy expired, leading to states reevaluating eligibility and resulting in a significant drop in enrollment.
😕 Medicaid's Administrative Hurdles and Impact
Paragraph two delves into the history and structure of Medicaid, established in 1965 alongside Medicare. It contrasts Medicare's federal nature with Medicaid's state-federal partnership, allowing states flexibility in program administration. While Medicaid can be life-changing for those with disabilities, the reality is that accessing and maintaining coverage is fraught with difficulties. These include complex application processes, long wait times, and frequent renewal requirements. The paragraph also criticizes the moralistic tone of some state policies, such as work requirements for Medicaid eligibility, which have proven to be more burdensome than beneficial.
😡 The Human Cost of Medicaid's Work Requirements
The third paragraph focuses on the negative consequences of implementing work requirements for Medicaid eligibility in certain states. Despite most adult Medicaid recipients already being employed, work requirements created unnecessary hardships. The case of Arkansas is highlighted, where thousands lost coverage due to administrative challenges, leading to severe impacts on individuals' health and employment. The paragraph also touches on the broader debate around Medicaid, with critics arguing against perceived abuses of the system, while advocates emphasize the need for healthcare as a basic right.
🤔 Medicaid Fraud and the Role of Managed Care Organizations
This paragraph discusses the issue of Medicaid fraud, emphasizing that it is often committed by healthcare providers rather than patients. It provides examples of providers defrauding the system, such as a North Carolina case involving millions and an Arizona case with fake rehab centers. The paragraph also criticizes Managed Care Organizations (MCOs), private entities contracted by states to manage Medicaid benefits. It raises concerns about their profit incentives leading to reduced patient care and cites cases where MCOs have been accused of denying necessary services to cut costs.
😤 The Struggles of Medicaid Recipients with MCOs
The fifth paragraph presents a case study from Iowa, where the transition to MCOs managing Medicaid led to a nearly 900% increase in members being illegally denied services. It tells the story of Louis Fender, a man with cerebral palsy, who lost essential care and medications after an MCO took over his care. The paragraph also includes a doctor's testimony suggesting that it's acceptable for patients to be 'a little dirty' to save costs, which is met with outrage by the patient's family and the narrator.
😩 The Complexities and Inequalities of Medicaid Eligibility
The final paragraph addresses the complexities and inequalities in Medicaid eligibility across different states. It uses a humorous yet poignant dialogue between various fruits and vegetables to illustrate the varying and often confusing requirements for Medicaid. The paragraph underscores the difficulties faced by individuals in understanding and navigating the system, suggesting that more streamlined and compassionate approaches are needed.
Mindmap
Keywords
💡Medicaid
💡Medicaid Unwinding
💡Administrative Cluster
💡Work Requirements
💡Managed Care Organizations (MCOs)
💡Eligibility Determination
💡Public Health Emergency
💡Overbilling
💡Healthcare Access
💡Universal Healthcare Model
💡Fraud Unit
Highlights
Medicaid is a massive public insurance program representing 1 in every 6 dollars spent on healthcare in the US, covering over 90 million people as of last year.
A process called 'Medicaid unwinding' has led to a rapid drop in enrollment, with hundreds of thousands of Americans losing their coverage, sometimes with no notice.
The unwinding began after a pandemic relief bill requiring states not to kick people off Medicaid expired in March 2023, leading states to start re-evaluating eligibility.
69% of those losing coverage had it terminated for procedural reasons like missing paperwork, with the majority not necessarily being ineligible.
Medicaid can be transformative when done well, providing crucial support like home health workers for people with disabilities.
However, Medicaid often doesn't work as intended, with administrative issues and barriers to access preventing eligible people from enrolling and maintaining coverage.
Even before the unwinding, in 2012 only 75% of eligible uninsured people were enrolled in Medicaid due to enrollment hurdles.
Some states have implemented work requirements for Medicaid, which has led to eligible people losing coverage and upending their lives.
There are concerns about fraud in Medicaid, but the costliest fraud is often committed by providers, not patients.
Managed Care Organizations (MCOs), which oversee 72% of Medicaid enrollees, are incentivized to cut costs at the expense of necessary care to increase profits.
There have been numerous cases of MCOs illegally denying care and prioritizing cost savings over patient needs.
The current unwinding and broader Medicaid system need to be run with more care, efficiency and oversight to better serve enrollees.
Potential improvements include using existing data to streamline eligibility determination, providing adequate resources for federal oversight, and holding MCOs accountable.
A universal healthcare model could be a long-term solution to the issues plaguing Medicaid and the broader US healthcare system.
Medicaid eligibility and enrollment processes vary significantly by state, with some states imposing strict requirements and limitations.
The talking peach Medicaid PSA humorously illustrates the confusing and inconsistent nature of Medicaid across different states.
Transcripts
our main story tonight concerns
Healthcare the industry that's done
basically no innovating in the past 50
years when it comes to big rolls of
paper you plop your bare ass
off specifically we're going to be
talking about Medicaid the public
insurance program that provides health
coverage to people with low incomes it
is massive representing one out of every
$6 spent on Healthcare in the US and as
of last year at least it covered more
than 90 million people the reason I put
that in the past tense is thanks to
something called the Medicaid unwinding
that number has been plummeting and fast
hundreds of thousands of Americans are
finding out they may be without all
important Medicaid coverage it's a
process they're calling Medicaid
unwinding they basically said hey sorry
uh you don't have insurance we took you
off the books they didn't even tell me
that it was dropped we have people that
we have served for 15 to 20 years and
suddenly they're dropped off Medicaid
it's true people getting kicked off
Medicaid and sometimes with no notice in
the last year net enrollment has dropped
by over 11 million individuals including
nearly 5 million children and just for
once could the government Blindside
people with something beneficial or even
just fun like if one day Congress
announced they'd be adding Shrek to
Mount Rushmore that would be something
he beening so naturally you may not have
even noticed he's in there there he is
right now and that is better Mount
Rushmore is better with Shrek on it and
the thing is all of this was to some
extent by Design the unwinding has its
Origins during the pandemic because when
covid started one early relief bill had
a requirement the states couldn't kick
people off Medicaid which was a good
idea given that there was a giant Global
Public Health Emergency and millions of
people were losing work and getting sick
but at the end of last March that policy
expired and for the first time in three
years State started checking people's
Medicaid Eligibility again some states
like Georgia even tried putting out PSAs
like this one to alert people to the
changes that we
coming hey did you know there may be
some big changes coming to your Medicaid
coverage you're a talking Peach sure am
but that's not important right now
what's important is that you visit stay
covered. ga.gov and update your contact
information why well the federal Public
Health Emergency may be ending soon so
it's important that you verify and
update your Medicaid account thank you
Mr py oh no that's my brother I'm George
it's excellent I mean it's all very good
but my favorite part there is the
Shopper saying you're a talking Peach
and it responding sure am but that's not
important right now uh disagree talking
Peach you're a piece of fruit that can
talk that is maybe the most significant
event in the history of humanity or
fruit if that were to happen every
government would have to rethink their
farming policies immediately the UN
would hold an emergency assembly
regarding the talking Peach issue and
how could anyone ever be comfortable
eating fruit again knowing that at any
moment it could go suddenly ow ow stop
you're hurting me now unfortunately
despite magnificent PSAs like that not
everyone heard about the Medicaid
unwinding or knew exactly what they had
to do to keep their health care and what
that has meant is that a process that
was theoretically just about removing
people who no longer qualified has in
many states turned into an
administrative cluster because 69%
of those who lost coverage had it
terminated for procedural reasons like
missing paperwork with that number
climbing as high as 93% in States like
Nevada and New Mexico that means the
overwhelming majority weren't
necessarily ineligible they might have
been their circumstances might have
changed but most lost coverage because
for one reason or another they or their
parent or Guardian never completed the
renewal process and for many that wasn't
their fault but the states take this
Florida family who received zero notice
that they had to do anything to maintain
their Medicaid coverage then suddenly
found that they lost it at the worst
possible time the past 24 hours have
been a nightmare for Liz Adams in that
time she found out her two kids were
dropped from Medicaid the news also came
a day before her 7-year-old son Brian
was set to have a biopsy procedure he's
currently in remission for leukemia I'm
mad I am mad I do not understand how
they can do this to a child Adams tells
us she never got a letter a call or any
other form of communication from DCF no
one else I can talk to not even the
doctor's offices can do anything they're
like we can tell them that it's
absolutely necessary that he needs
medical treat treat but we can't make
them give you your insurance back that
is terrible because anyone could tell
you that kid needs medical treatment I
could tell you that a magic eightball
could tell you that that octopus that
used to predict soccer matches could
tell you if you put out two pieces of
food each labeled with an option of what
to do it would ignore them both and
right in the sand what the is wrong
with you give the kid Medicaid you
monsters but the thing is everything
about the current unwinding is
emblematic of much larger issues with
how we've always administered Medicaid
so given that tonight let's talk about
Medicaid in general it was first enacted
in 1965 as part of the same law that
created Medicare the program providing
Health Care to the elderly and from the
start it was set up very differently
because while Medicare is a purely
Federal program Open primarily to
American 65 and older Medicaid is a
partnership between the federal
government and the states where the
federal government contributes at least
$1 in matching funds for every dollar a
state spends and while there are some
federal requirements that states must be
they get a lot of leeway in deciding how
to run their programs and when done well
the service they provide can be
transformative for instance Medicaid can
pay for people with disabilities to have
home health workers come and help with
mobility and daily living which is huge
as this activist pointed out a few years
ago when cuts to Medicaid spending were
being floated Medicaid paid for my
shower today made it so I was able to
eat breakfast help me put on my clothes
how's it going I breathe because of
Medicaid my
ventilator I move through the world
because of a wheelchair funded by
Medicade Medicaid touches everything in
my life and makes everything possible
exactly when Medicaid works it can be
amazing unfortunately it often doesn't
work that way which you can probably
guess by the fact that we're talking
about it now if this show was supposed
to make you feel good it wouldn't be
hosted by P it' be hosted by Stanley
Tucci can you imagine
you'd be watching an impossibly horny 30
minute deep dive on Negron right now
that's a better show I wish this were
that show you wish this were that show
but guys I'm sorry it just isn't the
thing is not all states offer care like
that or make it easy to get but there's
actually an even bigger problem here
which is that in general even for those
who qualify for Medicaid it can be
incredibly difficult to access and the
problems begin with basic administrative
fuckups like what happened to this
one-year-old in Florida Raven received a
Medicaid Health insurance card which by
the way has her correct date of birth on
it but the state kept rejecting it when
a doctor tried to run it on ground she's
not yet born she is not
born she is 13 months old alive but she
is not born she is still apparently a
fetus in my womb so I just pray she
doesn't get hurt or doesn't get severely
sick because I'm I'm out of luck they've
got copies of her birth certificate her
social security everything to prove she
was born including being physically
there wow that Family actually went
$2,000 into debt paying for routine care
for their child while the state tried to
figure out if she existed or not which
is ridiculous if you want to know if
someone was born here is a quick trick
just ask were you born if they say yes
they were born if they say no they were
born and if they just stare blankly at
you they were born I've made this into a
decision tree but it really doesn't feel
like that should have been
necessary for years people trying to
access Medicaid in their state have had
to navigate through poorly designed
websites long wait times and complex
forms and notices and those burdens have
had a real effect even before the chaos
of the unwinding in 20122 about a
quarter a quarter of uninsured people
eligible for Medicaid were not enrolled
in it often due to enrollment barriers
and the thing about Medicaid is you
don't just have to go through that
circus once you have to renew your
coverage every year which can be
incredibly honorous at one point
Tennessee was sending families who
wanted to renew their Medicaid a
questionnaire that could be as long as
47 pages and the state could be pretty
careless about doing that as one family
lost coverage after their renewal packet
was accidentally mailed to a horse
pasture which is obviously absurd
because horses aren't eligible for
Medicaid they get Healthcare through a
very different program called the glue
factory we all know this and look glitch
can occur in any system and they can
happen more often in government programs
which do tend to be underfunded
understaffed and operating on Ancient
technology and I'm not trying to reain
down on honest government employees
who have to process an endless barrage
of paperwork I have total sympathy of
how demanding those jobs are in fact
there's exactly one group of government
employees that is okay to make fun of
for something that is not their fault
and that is Secret Service agents for
the fact they are constantly being
bitten by the president's doc I'm sorry
I hope they're all fine but I'm still
going to laugh every time I think about
that but there are times when it feels
like the obstacles to getting Medicaid
have been put there deliberately so that
states can keep those that they see as
undeserving off the roles because States
get a lot of discretion in deciding who
is and isn't eligible for benefits and
in some they keep the bar to qualify
troublingly High all while adopting a
deeply moralizing tone take what
happened when the Trump Administration
gave some states permission to implement
work requirements as a condition of
Medicaid eligibility some were eager to
put those in place like this state rep
in Kentucky why do you think that work
requirements are going to
work it's an incentive I think that
there is dignity in work it's something
that is about the the the human person
so often I I say that our our sometimes
our charity becomes toxic to people in
our wanting to help them sometimes we
we've hurt them okay putting aside the
calling access to basic health care
charity is immediately infuriating it is
something that's about the human person
are you absolutely sure that's a
sentence because it sounds more like
something a drunk alien would say while
trying to describe a David Foster
Wallace book it's something that's about
the human person you know the humanoids
and their person
feelings but it's worth noting that the
majority of adults on Medicaid about 63%
are already working full or part-time
those who aren't are generally in school
or might have a disability preventing
them from working only leaving a very
small percentage of the population to
whom the policies could even apply now
fortunately Kentucky didn't end up
implementing a work requirement but
unfortunately Arkansas did and it didn't
go great for a start simply complying
with it was a hassle beneficiaries had
to report their work activities on a
glitch plagued web portal and just 6
months in 18,000 arons have been
stripped off Medicaid and locked out of
reapplication until the following year
and for some of those people who again
were already working losing access to
healthcare completely upended their
lives like this man who had a job at a
chicken plant Adrian McGonagle's Life Is
Coming Undone he became one of the
people that the state has booted from
the Medicaid roles in the last 3 months
he discovered this only when he went to
fill prescriptions at this drug store
and the pharmacist told him sorry your
coverage has been canceled and that it
was going to be like $340 for one of the
medications and like $80 for the other
one so he left empty-handed this was a
big deal because mogal has severe COPD a
chronic lung disease that makes it
difficult to breathe without his meds he
landed in the hospital multiple times
and missed a lot of work his supervisor
tried to accommodate him but he wasn't
healthy enough to perform his job so he
lost it yeah the work requirement for
Medicaid CA someone who was already on
Medicaid and working to lose both
Medicaid and their work which has to be
the most upsetting thing that's ever
happened in a chicken processing plant
apart from all the other things that
happen in there on purpose and while
Arkansas ditched that work requirement
after less than a year Georgia is now
experimenting with one and it is proving
just as stupid and just as frustrating
and that is the thing so much of the
talk around Medicade seems to Center on
the fear that someone somewhere might be
gaming the system you hear that argument
all the time the people in my district
that work hard that struggle to pay
their healthare they're very frustrated
when they see someone they know uh in
their small town where everybody knows
everybody they see someone that's not
working why should somebody have to go
to work every day and pay taxes to
provide something to someone who could
do the same thing but chooses not to and
I don't think it's unreasonable to say
that able-bodied people who are working
age who are not disabled who are not
seniors should have to go to work if
they want someone else to pay for their
health care look it goes without saying
that I disagree with Matt Gates on a lot
of issues his STS on immigration uh his
STS on gun control his STS on hanging
around with teenage girls we don't see
eye to eye on most things but on this I
particularly disagree because States
already aggressively monitor Medicaid
Eligibility and some of their efforts
can be deranged take Tennesse their
state Inspector General has a Medicaid
fraud unit that posts the names and
photos of people in arrests on a
government website and social media with
some even ending up on a most wanted
list this woman was charged with a
felony for supposedly receiving
Tennessee benefits while living in
Mississippi and wound up having to pay
$2,000 to bond out of jail and even more
to hire an attorney all just to show
that she'd not in fact committed
Medicaid fraud her driver's license just
had an outdated Mississippi address so
her only real crime there was not
wanting to stand in line at the DMV for
eight solid hours the head of that
Tennessee unit even acknowledged it cost
far more to run the Fraud Unit than the
office will ever recoup from people on
Medicaid who are usually lwi income
because even if the State recovered
every dollar from charges brought
against beneficiaries in 2022 the total
would amount to less than $900,000
compared to the office's budget of 6.4
million a year and look I'm not an
accountant despite having resting budget
analyst face but even I know that makes
no Financial sense and look I'm not
saying Medicaid fraud doesn't exist it
does but for the most part the costliest
fraud isn't being committed by patients
getting care they may not technically be
eligible for it's providers doing
like this a husband and wife living a
fairy tale lifestyle paid for by all of
us over a 3 to 4E period they were true
jet Setters in their private $900,000
plane the herens ran two Health Services
in North Carolina they build the state's
Medicaid system at least $17 million
most if not all of the patients they
claimed to help were already dead their
names gleaned from obituaries and
crosschecked with the
database that is obviously reprehensible
but if I could just give one quick note
to that news station everyone knows what
dead people are you don't have to show
b-roll of a cemetery for us to
understand the concept of death just
like when you said The Harens ran two
Health Services you didn't need to show
stock footage of a doctor writing
something down on a notepad but
interestingly you didn't do it all the
time did you like when you said the
phrase $7 million you didn't feel the
need to show this stock footage of cash
slowly falling out of the air but what
not how else will your viewers
understand what money is as if all that
weren't bad enough that guy liked to
post his business affirmations online
including never outlive your usefulness
doing big things requires one not to be
stuck on the little things and I'm not
doing a business that's new I'm doing a
new way of doing business a quote he
loved so much he posted it a second time
a month later but in red text instead of
yellow and I'll admit it didn't really
resonate when I read the yellow text
over dark green background version but
once I saw the red text over neon green
one I was like wow that is so
true that's totally what he was doing
but that is by no means the only case of
Medicaid providers defrauding the
government in Arizona there was a group
of fake rehab centers that for years
claimed fraudulent reimbursements for
patients who were either getting
Services they didn't need or not getting
them at all reportedly taking in more
than2 billion dollar from the state and
some of their submissions really should
have raised red flags like a bill for
alcohol rehabilitation for a 4-year-old
which is a little difficult to believe
if toddler alcoholism were a genuine
problem in this country You' have
definitely seen a TLC series about that
you know that is true and you'd probably
have watched it and while in both of
those cases the providers were
eventually caught it took years for that
to happen again and again the priority
seems to be making sure no individual
gets a penny more Healthcare than they
deserve even as states are weirdly BL
about much bigger amounts of money
flowing out the door to large
organizations and speaking of large
organizations there is one last massive
flaw with our Medicaid system and it has
to do with Managed Care organizations or
mcos these are private companies States
contract to deliver and pay for
healthcare currently 72% of Medicaid
beneficiaries are enrolled in a care
plan overseen by an MCO and it is Big
Business the five biggest mcos are on
the Fortune 500 including including
centine which has long been a favorite
of this guy
cenen yeah the healthcare plant provider
for government sponsored programs like
Medicare Medicaid this one's a long time
Kramer fa it's been out of favor but
Michael nidorf tells such a compelling
story Michael nidorf centine what a
horse that thing is you have impressed
me over the years as someone who is
really out for the consumer to get the
best health care you have Michael nid on
all the time no sen I think that Michael
nid is Amazing by the way he looks great
for 77 you got to get he's amazing and
he's just also a fantastic charitable
man okay you probably already knew that
cray was wrong about the company but
before we even get to that I'll point
out that the guy they just said looked
great for 77 was actually 79 and more
importantly died just four months later
it seems any optimistic prediction that
Jim kram is involved with is enough to
kill a business or even a
person seeing him compliment you on TV
is the closest thing we have to watching
the tape from the ring in your
life now as for centine itself there are
serious questions about how it's made
some of its money in 2021 after Ohio
sued it for over billing Medicaid it
settled and paid the state $88 million
in fact it's now settled allegations of
overbilling in at least 19 States for
nearly a billion and I would argue that
if you've had to do that you may not
deserve to exist as a company anymore
let alone have Wall Street's thirstiest
business boy go hubba hubba o over your
stock price and look Financial damage is
one thing but the most infuriating thing
about mcos is that as with so many
players in our for-profit health care
System they are incentivized to cut
costs at the expense of necessary care
because mcos get paid a set monthly
amount per person meaning they get a
fixed rate so their profit is whatever
they don't spend on patients and you can
probably see where this is going in
state after State there have been
heartbreaking stories of MC's denying
care and prioritizing cost cost savings
over patients there have been headlines
about this in Florida headlines about it
in Texas and headlines in Iowa and just
to focus on Iowa it transitioned to
using MOS to run its Medicaid Program in
2016 in just its first three years there
was a nearly 900% increase in members
being illegally denied services or care
and some of the cost cutting was
absolutely enraging like what happened
with Louis Fender who has cereal py and
was living with his mother he needs a
lot of care which prior to the switch
over was provided by Medicaid but once
an MCO got involved he lost a lot of
what he'd been getting starting with his
medications it was a nightmare it was it
was literally a nightmare and what am I
going to do I can't afford all that
medication also cut were his daily nurse
visits so for 6 weeks Louis went without
the inhome bathing and diaper changing
he had had for years he wasn't getting
changed like he would normally get
changed two or three times or more day
it wasn't just the services it was the
mental part of his his state of mind not
understanding why all this was happening
look that's obviously maddening and it
doesn't get any better when you hear a
doctor at a meral the MCO that took over
in Iowa explaining in a hearing about a
similar patient just what the corporate
thinking was about the necessity of
keeping people clean people have bow
movements every day where they don't
completely clean themselves and we don't
fuss over too much people are allowed to
be dirty you know I would allow him to
be a little dirty for a couple
days look I'll be honest when I first
heard that I thought that has to be
taken out of context there is no way a
doctor a licensed physician would
testify in a hearing that he thinks it's
okay if people have on them for
days so we got the full hearing I'm not
going to play it for you I'm just going
to tell you he said it he meant it and
it made me want to punch a hole in the
wall and just watch what happens when
Lou mom were told about what that doctor
just said what would you say to him if
you could if he was here I would spit in
his face to be
honest yeah right Louie you like to be
clean I think it's horrible I I don't I
don't have words for that yeah I'm kind
of struggling for Words too although I
will say Lou did kind of nail it there
by blowing that raspberry and I also
appreciated that reporter doing a full
gym from the office look to camera and
nodding but if I absolutely had to put
it into words I guess I'd say that
doctor with a rusty canoe I hope he gets
tetus of the balls and if he has a
problem with my language there I'd say
I'm allowed to be dirty people are
allowed to be a little dirty sometimes
apparently that's doctor's
orders and while legally I have to tell
you Amer Health eventually restored Lou
service it is a disgrace it was even a
fight to begin with look the reality of
Medicaid is that too often it's hard to
get easy to lose and not a priority for
the government or the companies we hire
to deliver care so what can we do well
as I've said before I personally think
the big solution here is to adopt a
universal healthcare model but in the
meantime I'd argue both the current
unwinding and Medicaid programs in
general need to be run with
significantly more care and efficiency
and there are ways to do that for
instance when it comes to determining
eligibility maybe rather than sending 47
page forms to horses states can instead
rely on information they already have in
their databases that seems like it would
make a bit more sense and Michigan is
actually a good example here it worked
with a design nonprofit to retool its
application and renewal processes for
all public benefits and the result was
that 95% of renewals were submitted on
time with a 60% drop in user errors on
the federal end Congress could ensure
that uh that the agency that administers
Medicaid has the resources it needs to
oversee State compliance and finally
when it comes to mcos if they are going
to continue playing a role here there
clearly has to be way more oversight
with performance reviews being thorough
and public especially when it comes to
things like denials of care and until
such time as we do all of that the very
least we can do is make Medicaid PSAs
that actually prepare people for the
realities of our current mess of a
system hey did you know you might be
eligible for Medicaid you're talking
Peach sure am but that's not important
right now what do you mean you can talk
could all peaches always talk sure we
could but don't focus on that because I
want to talk to you about Medicaid is
anyone else seeing this talking Peach I
see it too mommy the process of getting
on Medicaid is different depending on
where you live okay the good news is
that pretty much in all states generally
low-income children pregnant women and
families and people with disabilities
are eligible for Medicaid with some
exceptions are there going to be a bunch
of loopholes or something oh
you have no idea well he's right take my
State Texas oh my God there's more of
you mama what is that thing well I'm a
sweet potato now let's say you're a
single mom with two kids if you're
making over
$334 a month you're not eligible for
Medicade at all it's true and in Georgia
if you don't have kids you better be
working otherwise you can't get Medicaid
hey good for you you're not running a
charity over there there's dignity in
work it's something about about the
human person yes I agree hey y'all I'm
from Louisiana mom what's up with this
one's eyes yeah this one's got wrong
eyes in my state we check your finances
every 3 months to make sure you haven't
gotten some overtime or picked up some
season work or nothing guess what in
Wyoming if you're an adult without kids
or disabilities or a pregnancy you can't
qualify for Medicaid at all no matter
what your income is there's literally
Lally no way to qualify for it oh my
Lord is that true even if you're like
out of work and like making no money yes
honestly that's up it is
up I agree with the coconut that's super
up mommy I'm scared I know buddy
come over here stand on this side away
from the produce that's a cute kid you
got there thanks don't worry his
Medicaid coverage won't be cut I smell
more loopholes unless yes you
don't fill out the proper paperwork but
also maybe if you do but there's a
glitch in the system like I don't know I
mailing your form to a horse Pastor oh
it's happened y'all mhm hey how do we
know your kid was really you know born
anyway excuse me yeah if that kid wasn't
born then he doesn't get Medicaid prove
he was born prove he was born prove he
was born prove he was born he was born
Pro he was born was I born prove he was
born prove he stop prove he was born I
don't have to prove anything to you your
vegetables the child is the brute listen
I know this is all complicated so feel
free to just give your State Medicaid
office a call if you have any questions
be patient though in Florida it takes
more than an hour to get a live person
on the phone no way dude
I don't speak Spanish he said there's an
80% chance your car would disconnect by
accident what's the point of even
calling them because it's a fun thing to
do I agree with that okay we're leaving
now thank you Mr pachy oh Mr pachy is my
brother and you ate him last week what
and now we're going to eat
you oh
[Music]
oh
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