Medicaid: Last Week Tonight with John Oliver (HBO)

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

Channel: LastWeekTonight

Views: 1,742,926

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Id: bVIsnOfNfCo

Length: 28min 12sec (1692 seconds)

Published: Thu Apr 18 2024