Dear GOP: Eliminate Waste And Fraud To Help Pay For Healthcare Bill

Ronnie Shows | Former Democratic Congressman

A lifelong Democrat, I am not sorry to watch Republicans in Congress struggle to undo the Patient Protection and Affordable Care Act, also known as Obamacare. Now, the Senate has agreed to delay a vote until after the Fourth of July, and the GOP will spend the next few weeks trying to craft legislation that appeals to both the moderates and the most conservative members of their caucus.

The dilemma facing Senate Republicans, and the Majority Leader, Mitch McConnell, is that if the bill spends too much on programs like Medicare and Medicaid, it will lose the support of the most conservative Senators, like Rand Paul, Mike Lee and Ted Cruz. However, if they spend too little on those programs that millions of Americans rely on for healthcare, they will lose the moderate Senators like Ron Johnson, Dean Heller and Susan Collins.

Now, I don’t like the current version of the Senate bill to repeal to Obamacare. In my view, it puts too many low-income and middle-class Americans at risk of losing access to healthcare. However, while I don’t support the GOP repeal of Obamacare, if done correctly, it could improve some aspects of our healthcare system and make the bill more palatable to all Republican Senators. Specifically, I am talking about eliminating wasteful spending. If Republicans want to cut spending so badly, why not eliminate fraud and abuse, rather than taking healthcare away from poor people? In fact, most people would be shocked if they understood just how much taxpayer money is stolen by bad apples in the healthcare sector.

According to one government analysis, Medicare fraud costs the American taxpayer over $50 billion dollars a year. Last year, the Department of Health and Human Services stated that improper payments under Medicaid accounts for over 10 percent of total Medicaid spending — coming to $139 billion dollars.

Sadly, when it comes to healthcare fraud, mental health and drug treatment programs are some of the worst actors. This is due partly to a 2007 law that provided generous insurance benefits to those suffering from mental health and substance abuse disorders. Additionally, Obamacare permitted adults under 26 to use their parents’ coverage, and required insurance companies to cover pre-existing conditions and pay for drug relapses. With this new category of young addicts with benefits, there was rampant insurance fraud.

One company with a problematic record was Psychiatric Solutions, Inc. Pro Publica, an organization of investigative journalists, found PSI decreased staff to generate profits. Understaffing and inadequate worker training led patients to suffer serious harm, including violence, suicide attempts and medication errors.  A shareholder lawsuit filed against PSI in 2009 alleged abuse, neglect and even death of patients. PSI was eventually purchased by Universal Health Services in 2010, which settled the lawsuit for $65 million in 2015. Now, UHS has more than 200 psychiatric facilities across the country and more than a third of the company’s $7.5 billion annual revenue comes from Medicare and Medicaid. 

An investigation of UHS by the online publication BuzzFeed, revealed that high profits have been achieved at the expense of patients. Two-dozen current and former employees at 14 UHS facilities across the country told BuzzFeed that the company only wanted to keep patients until their insurance ran out. Following the exposé, UHS has been under federal investigation by two federal agencies and there’s a class action lawsuit pending.

Notably, after PSI was acquired by UHS in 2010, most of its executive team moved to Acadia Healthcare, which went public around the same time the PSI team took over. Of the seven individuals Acadia lists as the senior management team, all but one previously worked at or with PSI. As at PSI, employees at Acadia have reported disregard for employee and patient safety and alleged the company cherry picks patients based on their insurance benefits. Clearly, the government, specifically the Centers for Medicare and Medicaid Services, needs to investigate.

I am singling out PSI, UHS and Acadia, because they’ve received media attention, but there are many more bad actors.  Just last week, the New York Times published a devastating report about fraudulent drug treatment centers in Florida.

To try and lure Republican Senators to vote for the bill, the White House and Senator McConnell are dangling about $200 billion dollars in tax savings, to be used for programs like healthcare savings accounts to appeal to conservatives, and opioid treatment to appeal to moderates. Oddly enough, if Congress could eliminate waste and fraud tied to Medicare and Medicaid, they would have another $200 billion dollars to appeal to wavering Republican Senators. This $200 billion could be raised by stopping the theft of taxpayer dollars — not taking away healthcare from poor pople. I support fixing Obamacare this way. It would appeal to both moderate and conservative Republicans, and ensure healthcare coverage for millions of Americans.

Shows, a Democrat, represented Mississippi’s 4th Congressional District from 1999 – 2003. 

Tags : american health care act healthcare house of representatives mitch mcconnell ronnie shows
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