Alternative Explanations

 8/25/25 Federalist discusses evidence of fraud in both Obamacare programs and Medicaid:

The first data point came via the federal Centers for Medicare and Medicaid Services (CMS), which released data from exchange insurers’ risk adjustment submissions. The spreadsheet contains enough numbers to make one’s head spin, but two sets of numbers — lines 4 and 7 of the spreadsheet — stand out. Those two lines show that the percentage of enrollees in Bronze and heavily subsidized Silver plans without claims rose from roughly one-quarter (29 percent and 23 percent, respectively) in 2019 to 40 percent last year.

To some, that change may not seem like a big deal — after all, isn’t it a good thing when people don’t make claims on their health coverage? But it suggests that, after four years of Biden administration policies, a growing number of individuals were being auto-enrolled (and/or automatically reenrolled) into taxpayer-funded “free” health coverage that they did not want, need, or use.

Indeed, the spreadsheet shows that 39% of enrollees made no claims in 2024.  There is another explanation.  The deductibles on these plans are enormous.  The weighted average for 2024 was about $2700.  If you are a typical young person, you might well have such a small need for medical care that you decide to not make a claim unless you expect to meet the deductible; you may also take advantage of lower costs from self-pay.  Indeed, one of the reasons that ACA mandated insurance for all was that young people would not enroll, because of a perceived lack of need.  This would make insurance for older people even more prohibitive than it is.

Another part of the article is more concerning:

According to the auditor’s report, from February 2019 through this March, Louisiana paid at least $9.6 million providing Medicaid coverage to 1,072 beneficiaries after their date of death. Because Louisiana, like most states, runs its Medicaid program through managed care organizations, those insurers get paid per month for every enrollee, whether the enrollee sees the doctor or not. If the state Medicaid agency does not properly report a beneficiary’s death, the insurer will get paid in perpetuity for “covering” that dead enrollee.

That’s exactly what happened in Louisiana. For the cases examined, insurers were paid a median of 418 days — that’s nearly 14 months — after the beneficiary had died. For the 168 deceased beneficiaries the auditor identified via the Social Security Death Master File, insurers had been receiving payments for a median of 799 days — more than two years.