It Just Keeps Getting Better and Better

…or worse and worse, depending on your perspective.  Not only is the Veterans Administration continuing to make bad/false/improper payments, they seem to be getting acceleratingly worse about it.  The Veterans Affairs Office of Inspector General reported that the VA made $5 billion in “improper” payments in 2015, and then while that drew attention, the VA increased their improper payouts to $5.5 billion in 2016.

To show how terrible the rates can be, here are some data from James Clark at the above link:

  • the VA Community Care had 75% of their payments as “improper” payments in 2016
  • the Purchased Long Term Services and Support 69% of their payments as “improper” in 2016

You read that right: three out of four of the Community Care’s payouts were wrong, and over two-thirds of PLTS&S’ payouts were…erroneous, and they’re getting worse.  The prior year, those payout rates were “only” 54.77% and 59.14%, respectively.

Since the VA empirically no interest in cleaning up its act, since it insists on wasting money our veterans need for their care, it’s time to disband this miserable excuse for an institution and commit its budget to vouchers for our vets.

No more delay by Congress.

Veteranos Administratio delende est.

Medicaid Cuts?

Some conservative Republican Senators are looking to cut Federal transfers to the States earmarked for those States’ Medicaid programs.  Others are concerned.

[T]he [conservative Senate Republicans’] Medicaid plan could affect many more people and shift significant costs onto hospitals and states.

One State’s Medicaid program, though, should be paid for exclusively by that State and not subsidized by the other 49 through those Federal transfers. Medicaid is, after all, a state program by design, and Medicaid eligibility is determined by each State.  The Federal transfer subsidies are made the more egregious by the fact that each State determines its own citizens’ eligibility for Medicaid, and that eligibility is income-based—with the maximum income for eligibility in most States being a multiple of the Federal Poverty Guidelines.  This means that in those States, a citizen can be eligible for Medicaid funds even though, by definition, that citizen isn’t in poverty.  Other States ought not be required to subsidize, through Federal Medicaid transfers, such eligibilities.  Not only are the States are defining “low income” much too loosely, other States have to pay into those definitions.

If each of those other 49 were able to keep the monies collected by the Feds for transfer, they’d also have more money—of their own—with which to fund their own Medicaid programs, and each of the States, absent attendant Federal strings, would be freer to structure their individual Medicaid programs according to their own citizens’ needs and demands.  As it is, States wanting to structure their programs must waste time and resources pleading to the Feds “Mother, may I?” and then argue the matter.

Such State-initiated restructuring—subject to central government approval—already is beginning to include things like work requirements, drug testing and time limits on coverage, all of which would free up State resources for the State’s truly poor.  Federal cuts to transfers to State Medicaid need not interfere with this; on the contrary, such cuts would encourage needed restructuring, while moving to insulate each State from other States’ decisions.

Of course, such Federal transfer cut would have complex implications and require serious Federal tax code restructure and reform—the taxes the Feds transfer for Medicaid come from a variety of sources: individual and business income taxes, dividend and cap gains taxes, and on and on.

That just puts a premium on getting started.