Obamacare’s history is one of policymakers disregarding the law to achieve greater control over their fellow citizens. So the Trump administration’s recent announcement that it will stop issuing unlawful and often fraudulent Obamacare subsidies is a welcome departure from that history. The administration has also taken worthwhile steps to curb Medicaid fraud.
The administration should go further, and not just in Obamacare. Fraud occurs at intolerable levels throughout government health programs. The New York Times cites a Congressional Budget Office estimate that there are perhaps 2.3 million cases of the federal government issuing improper Obamacare premium subsidies, but the administration is canceling just 750,000. Likewise, every year since 1990, the Government Accountability Office has warned Congress that Medicare poses a high risk of “waste, fraud, abuse, or mismanagement.”
The GAO has issued a similar warning about Medicaid every year since 2003. We’re talking hundreds of billions of dollars per year. The administration’s current efforts are hardly sufficient.
Opponents say the administration’s anti-fraud efforts are more about politics than policy. They allege the administration is selectively targeting Democratic states. That’s probably correct—and scarcely different from Obamacare supporters rushing unlawful subsidies into voters’ hands because they hope it will motivate them to vote. “There’s gambling in the casino!” protest the casino builders. This is not an argument against what the president is doing. It’s an argument against giving any president or government control over our health care.
What the Trump administration is not doing is making health insurance more affordable. Expanding access to Obamacare-exempt plans, as President Trump did via rulemaking in 2018, would reduce health insurance premiums by 60 percent or more for most individual-market consumers. Trump should demand that Congress codify his 2018 rule. If Congress won’t act, the administration should reissue that 2018 rule.
We are almost at the halfway point of Trump II, but his administration is still overthinking this short putt.
