It wouldn’t be mine 
. We already KNOW that states with higher taxes (like California) would charge a lot more than anywhere else. They’ll find something to spend it on.
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More Medicaid abuse by all states except Alaska
Republicans are looking at substantial spending cuts to help reduce the nearly $2 trillion deficit and keep the economy moving. And one big, fat, juicy target for savings is a Medicaid funding scam that lets states steal tens of billions of dollars from the federal government every year.
Here’s how this particular scam works.
States tax health care providers and use those funds to help cover their Medicaid costs. Then, the states turn around and increase what they pay these same providers for Medicaid benefits – effectively covering the cost of the tax. Then, because of the way Medicaid is financed, the states can bill the federal government for half of the spending increase.
Let’s say, for example, a state imposes a provider tax on hospitals that raises $100 million. And then it returns that $100 million to the hospitals in the form of higher Medicaid reimbursement rates. There’s been no increase in benefits. Providers aren’t better off. But the state gets an extra $50 million from the federal government’s matching fund, money that it can use for anything it wants. (The fed pays states up to 90% to cover the cost of expanding Medicaid under Obamacare.)
An Oregon state representative once called it a “dream tax.” States can use Medicaid to steal money from the federal treasury. It’s such a wonderful dream that Alaska is the only state in the nation that hasn’t leveraged it.
We’re not talking pennies here. The Congressional Budget Office figures that the 10-year cost of this tax scam is more than $600 billion, which is almost exactly what Republicans are eyeing in savings from Medicaid. Provider taxes are now the second largest source of funds for Medicaid.
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A federal judge is doging the Los Angeles homeless-industrial complex scam
Los Angeles City officials have lost track of billions in spending on homelessness services, according to an independent audit released on March 6.
The audit was commissioned by federal U.S. District Judge David O. Carter and completed by Alvarez & Marsal Public Sector Services, LLC. (A&M).
The report noted that A&M found it challenging to completely quantify how Los Angeles officials spent approximately $2.3 billion in funding meant to shelter, feed, and serve homeless people due to the incomplete and inaccurate manner the city’s homelessness program recorded and collected data.
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That may be the article’s lead, but it doesnt seem to be all that representative of the audit’s findings…
Fragmented data systems across LAHSA, the City, and the County and inconsistent reporting formats made it challenging to verify spending and the number of beds or units reported by the City and LAHSA, track participant outcomes, and align financial data with performance metrics
Reading the meat of the story makes it sound more like they cant measure the bang for the buck, not that the bucks were missing. There’s a risk they were paying invoices for services not received, but mostly they just couldnt tell what tangible effect this money had on the homeless problem (hypothetical example: they spent $X on a soup kitchen, with no data on how many homeless persons were fed or how much of the food purchased was actually used). There’s no mention of any suspicion that the money went somewhere other than towards homeless services.
How is that different from losing track of billions of dollars? One man’s can’t measure the bang for the buck is another man’s losing track.
If money was spent on a contract providing up to 250 shelter beds, nobody lost track of that money. Not knowing how many of those beds were actually utilized by the homeless is measuring the bang for the buck. They’re pretty distinct terms, and not at all interchangable.
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I agree this does sound murky. Reminds me of a shell game. States don’t want to appear to raise taxes to fund their share of Medicaid so they steal from the Federal government. …
I wonder why the 1991 law that was supposed to prevent this, no longer applies. Is it because of ACA?
Also if every state but Alaska does it, I’d like to know who the worst offenders are. It’s easy to pick on California since they are the largest state by some margin. I wonder if anyone quantified this abuse per capita. Either way, it doesn’t seem like a bad thing to shut down.
Either way, all this would be moot if Medicaid/Medicare was 100% a State thing. Shift the Medicaid/Medicare part of FICA (1.45% for employee and employer) directly to each State. And let each State pay 100% of their Medicaid/Medicare program costs. It’d be obvious then that States that have more costly programs covering illegals, etc., would need to openly raise taxes on their constituents for it rather than socializing it across the whole country and adding to US debt instead of their own State debt.
Roll back the expansions?
Subsequent expansions of Medicaid have not demonstrated the same value, however [as benefits to the poor, children]. A randomized expansion of Medicaid to able-bodied adults in Oregon yielded “no statistically significant effect on physical health,” though it increased the use of medical services and reduced patients’ out-of-pocket costs.
This is because later expansions of Medicaid have gone disproportionately to wealthier households, many of which already had private insurance coverage. Some Medicaid eligibility expansions saw private insurance enrollment fall by as much as 60 percent of the increase in public insurance rolls.
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If you want to screw over early retirees.
I’m the last one to endorse the socialized medicine proponents’ characterization of high deductible cheap health insurance, without all the expensive mandatory coverage of Obamacare, as “junk plans”. But it seems some people are in fact selling junk plans and you should be aware if shopping that there’s a bunch of shady telemarketers out there lying about the coverage they are selling.
The loophole appears to be hiring you for some super nominal job, like installing an app that tries to sell your browsing info or something, which allows them to offer you a employee plan which are much less regulated and can be, although usually aren’t generally, offering much much less coverage.
I’m not going to cry for this tho -
If the plans become popular enough, Obamacare’s defenders warn, they could blow up the private health insurance market. The idea behind the Affordable Care Act is to gather both sick and healthy people into the same insurance pool. If fake-job plans lured significant numbers of healthy people out of the pool, prices for those remaining could skyrocket, leaving the sickest uninsured. It’s what the Leukemia & Lymphoma Society, in a court brief opposingthe fake-job idea, calls a “classic insurance ‘death spiral.’” (In his statement, Bryan said he’s serving people who can’t afford or don’t want Obamacare and called the death-spiral scenario “absurd.”)
The ranks of uninsured Americans are likely to grow. Extra subsidies approved in 2021 helped millions sign up for Affordable Care Act plans for the first time. Those subsidies are scheduled to expire at the end of this year. Unless Congress acts, the number of uninsured may rise by almost 4 million, according to the Congressional Budget Office. Many might be tempted by telemarketers offering cheap alternatives.
They mean better cheaper alternatives, including those priced off medical history (rather than guaranteed coverage under ACA), could blow up the public Obamacare market via the death spiral from adverse selection effects. Which already cause it to be bad and have poor coverage and networks, very high deductibles, etc.
California is paying about $9.5 billion per year for illegal alien Medicaid coverage.
More detail from the LA Times
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The new tax bill also has a work requirement for Medicaid somehow, TBD.
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Where’d you get the $9.5 billion? It’s not in either article.
NYT cites over $9B below
https://www.nytimes.com/2025/05/14/us/california-newsom-healthcare-budget.html
Medi-Cal benefits for undocumented immigrants have cost the state at least $2.7 billion beyond the $6.4 billion the state anticipated when eligibility was expanded last year. More undocumented immigrants signed up for Medi-Cal than expected, and the costs for their prescriptions were higher than projected.
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That’s a lot of money. But the total Medi-Cal budget is $161B, so in that context it makes more sense. The total is still huge, considering that it only covers 14.5 million people. Our healthcare costs are insane…
Still, 6% of such a huge healthcare cost should give pause on whether it’s wise to spend it on illegals. The costs per capita being so high should point to trying to make cuts where you can to bring them down.
Even then, healthcare cost per capita is not the worst in CA compared to other states: 2020 data on healthcare expenditure per capita
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Related, the GOP wants to let the Covid-era adjustments to how the ACA subsidy is calculated die. Affects the poor, and tangentially early retirees with deliberately low income like me.
The effect on the subsidy isn’t much but reinstating the benefits cliff is pretty bad, The status quo caps repayment at ~$3000. If it reverts, you must pay back the entire thing if you’re even $1 over the income limit.
And oddly enough, it’s not just rich people with volatile income. There is another study on this KFF site modeling how many relatively low income people that this can hurt.
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These fiscal cliffs like IRMAA brackets are just poor policy design. Sounds like more of the same for ACA subsidies assuming these even survive anyway.