Dr. Paul Winfree - Medicaid Fraud

Episode Transcript

Speaker 1 (00:00):
Oh Canada, crapsing the economy, recession looming.

Speaker 2 (00:04):
What happens next? Watch what happens? Will happen right here.

Speaker 3 (00:08):
On fifty five KRC, the talkstation Ato six here fifty
five car CD talk station and a happy Thursday to you.
Out of the r with Irbdadation Next.

Speaker 2 (00:19):
Mer Jay Rattler.

Speaker 3 (00:20):
But right now I'm really excited and please welcome to
the fifty five KRC Morning Show. Doctor Paul Winfrey, President
CEO of an organization called the Economic Policy Innovation Center.
He served a top management policy roles in the White House,
US Senate as well as think tanks, and during the
first Trump administration, he served as the Deputy Assistant to
the President for Domestic Policy and Deputy Director of Domestic
Policy Council. His research has been featured in The Wall

(00:43):
Street Journal, New York Times, Washington Post, Investors, Business Daily,
USA Today, in Congressional Quartery, among other publications. Also the
author of the History and Future of the Budget Process
in the United States. Doctor Winfree, Welcome to the program.
It's a real pleasure to have you on, sir.

Speaker 4 (01:00):
Thanks for having me. I appreciate it. Well.

Speaker 3 (01:02):
When you read the news, you think the world is
coming to an end. Oh my god, eight point six
million people are going to be deprived of healthcare if
these reforms go in that the Republicans are talking about.
Let us start with it seems to me that many
of the Democrats who are railing against requiring people who
are able bodied in their prime work years to actually
participate and work or do something for twenty hours a week,

(01:25):
they shouldn't be on Medicaid. Can you remind my listeners
who may be on this fence and about the issue,
what Medicaid was originally designed to do.

Speaker 4 (01:36):
That's exactly right.

Speaker 1 (01:37):
I mean, if you break down the eight million person
number or the eight million lost coverage number, one point
four million of those folks are illegal immigrants. One and
a half million of them are not eligible for Medicaid,
but they've been retained on the program by regulations that
are promulgated by the Biden administration. Another couple of million
are people who don't even exist right now, but CBO

(01:59):
says may exist in the future and maybe eligible for Medicaid.
And everybody else are working age adults who are healthy
and currently on the program and don't have any don't
have any requirement to work. When the program was created,
as you mentioned in the nineteen sixties, this was a
program for the vulnerable folks, the disabled, the blind, pregnant

(02:22):
moms and kids. And what we've seen over the last
ten years is the program has evolved to benefit the
healthy adults without dependence over the truly vulnerable, which is
changing the way that medicine is delivered and ultimately making
it harder for folks who truly need the Medicaid program
to see to see doctors, and to get the healthcare

(02:45):
that they ultimately need.

Speaker 3 (02:46):
So what they've done is they've undermined Medicaid's original intent.
They put all these people on who weren't eligible for
it originally. How is it that it expanded so much
and people didn't say, well, well, whoa whoa, we're we're
this is this has gone way on the scope of
what was truly intended, yeah.

Speaker 4 (03:04):
To get this.

Speaker 1 (03:05):
When Obamacare was created in twenty ten, and then it
expanded the Medicaid program to the healthy adults in twenty fourteen,
they knew that states would be disinclined to expand Medicaid
to the healthy population because it would have added to
their state budgets, and so what they did is they
set up a new financing structure that rewards states for

(03:27):
enrolling healthy adults. So for every one dollar that states spend,
they get nine dollars from the federal government if they
enroll in help healthy adults without kids, and they get
a dollar thirty three for every dollar that they spend
for every pregnant mom, disabled person, blind person, elderly person

(03:48):
or child that they put on the Medicaid program. And
so if you think about it that way, from a
state's perspective, they're literally rewarded by the federal government for
enrolling and shifting medicine towards healthy adults over people who
truly need it. And and that those those incentives have
become even more strengthened because of some Biden regulations that

(04:11):
have been pushed out over the last four years that
have just accelerated that and encouraged states even more to
take up the Obamacare expansion. And that's that's that's really
what we're talking about here.

Speaker 3 (04:24):
So the left has been advocating for universal health care.
I mean it was supposed to Obamacare is supposed to
do that. I know Hillary Clinton never to do it
back when she was the first lady. But obviously it
didn't go through then. But this sounds just like a
nefarious backdoor mechanism to create that reality because more and
more people are expanded put on Medicaid and are not
in private insurance or or dealing with it on their own.

(04:44):
Is that that kind of what's actually unfolding here, Bingo,
you're exactly right.

Speaker 1 (04:50):
So the left has been talking for years about Medicare
for all, right, Bernie Sanders has been talking about Medicare
for all for years.

Speaker 2 (04:56):
You've got bills to do this.

Speaker 1 (04:58):
Democrats in the House, Aos, they also have bills to
do this. The real trojan horse here is that it
was never intended to be Medicare for all. It was
intended to be Medicaid for all. And one of the
big differences that seniors know between Medicare and Medicaid is
that doctors get paid much less for seeing the vulnerable

(05:19):
population in Medicaid than they do for Medicare or private
health insurance.

Speaker 4 (05:24):
Or even Medicaid for the healthy.

Speaker 1 (05:26):
Adults because of the incentive structure to push medicine towards
the healthy adults in the Medicaid program. What that means
is that right now today there are about seven hundred
and ten thousand disabled Americans on Medicaid wait lists to
get things like home health care because the states have
again been incentivized not to spend on that population because

(05:51):
that's what the federal government has been telling them to do.
And if they keep moving this in the tenet non
expansion states expand Medicaid like Texas and Florida and Georgia,
then we are going to become that much closer to
a Medicaid for all system where there's just a takeover
of healthcare and it's all run out of HHS.

Speaker 4 (06:13):
That's where we're going right now.

Speaker 1 (06:14):
Eighty million Americans are on Medicaid, a program that was
originally intended to be for the truly vulnerable.

Speaker 3 (06:21):
And I know you've pointed out in your research, your
in your writings on this that states exploit medical Medicaid
with with what you referred to as loopholes, private provider
taxes and state directed payments which you I think referred
to as money laundering schemes.

Speaker 2 (06:36):
How do these work?

Speaker 3 (06:36):
And isn't this a reform that should be incorporated into
what the Republicans are trying to do right now?

Speaker 1 (06:42):
So the Medicaid provider taxes. If if the private sector were.

Speaker 2 (06:46):
To do this, it would be illegal. People will go
to jail.

Speaker 4 (06:50):
Literally.

Speaker 1 (06:50):
What happens is that the states tax medicaid providers, insurers,
and hospitals in particular. They then re burse the same
amount of money that they're taxing the hospitals and the insurance.
So they pay the insurers and the hospitals to pay
the tax. They then bill the federal government for the

(07:12):
amount of that tax, and the federal government reimburses the state.

Speaker 4 (07:16):
The states then split the.

Speaker 1 (07:18):
Money that they get from the federal government with the providers,
so they send it to the insurers and through higher
capitation rates or higher premiums, and they send it to
the hospitals through to higher payments.

Speaker 4 (07:31):
But here's the really wild thing that's going on here again.
Because states get.

Speaker 1 (07:38):
Nine dollars from the federal government for every one dollar
that they spend on the healthy population, they're incentivized to
gain this in particular in the direction of the healthy population.

Speaker 4 (07:52):
And so what we're seeing right.

Speaker 1 (07:54):
Now play out in quite literally real time is that
there's a pollution between state governments and the hospitals and
the insurers to figure out ways in which they can
increase premiums and prices for the healthy adult population to
take advantage of these money laundering schemes. And what that's

(08:16):
doing is it's quite literally redirecting the way that medicine
is delivered so that the vulnerable folks don't want to
be seen by doctors. Rather, the doctors want to see
healthy folks because they get paid more for seeing them
by the federal and state governments.

Speaker 4 (08:33):
And personally, I mean, just as a as a.

Speaker 1 (08:35):
Tax paying American, I think that that's wrong, and I
don't want to see my own my own tax dollars
go for things like that.

Speaker 2 (08:43):
That structure is just.

Speaker 3 (08:46):
I'm just mine. My mind is boggled by this, doctor Winfrey.
And then that's the way it exists, creating zero incentive
whatsoever for states to want to reign in or or
ride heard over the medicaid dollars that are being spent.
I mean, there's zero incentive there.

Speaker 1 (09:00):
Their zero incentive. And we've seen, I mean, your listeners
know exactly.

Speaker 2 (09:04):
The states that have abused this the.

Speaker 1 (09:06):
Most without me even saying the names, California and New York.
But California and New York have used these money long
during scams to funnel more and more money back to
the back back to the state governments from the Feil government.
They've then used the profits from these money laundering scams
to provide health insurance medicaid for illegal immigrants, but also

(09:29):
to pay for things that have absolutely nothing to do
with healthcare to fund budget shortfalls in their own states.
And they're doing this on the backs of medicaid. They're
literally using medicaid to funnel federal money back to the
state to fund their budget, fund their budget shortfalls. And
so Congress is looking right now at closing or at
least limiting.

Speaker 4 (09:49):
Some of those loopholes.

Speaker 1 (09:51):
But really I think that they can go even even
further than what than what they're doing well.

Speaker 3 (09:58):
And you know, it's sort of like I wish the
American public who could listen to this particular interview now
or at least have the understanding that doctor Winfrey here has,
because then they would easily reject these screams and wailing
and gnashing of teeth about all these eight million people
are going to lose their medical benefits because as you
describe it, of course clearly they shouldn't have them anyway.

(10:18):
But the idea that this system has been so upside
down that it incentivizes treating the healthy people to the
exclusion of the original point of Medicaid.

Speaker 2 (10:27):
I think would rile people up and will be anger.

Speaker 4 (10:32):
That's exactly right.

Speaker 1 (10:33):
The Congressional Budget Office just last week put out a
letter that said that if you reduced the f MAP,
or the amount of the federal contribution for the healthy population,
down to the rate that the philogarment paced for the
vulnerable population, it will save about seventy one billion dollars
a year. At the same time, only about two million

(10:57):
people will become uninsured based on their estimates. If you
divide the seventy one billion by the two million, you
get about thirty thousand dollars a year that the federal
government is paying to ensure the marginal person on the
Medicaid program, even though the even though the federal government
tells us that it only costs about eight thousand dollars

(11:19):
to ensure a person on Medicaid. So one has to
ask the question where did the other twenty two thousand
dollars go? And the answer is that it's being channeled
to the state governments and the insurers and the hospitals
which is why those groups are the ones that are
actually panicking about what Congress is doing right now and
trying to incite a riot in Washington, DC amongst the

(11:43):
vulnerable Medicaid recipients.

Speaker 3 (11:45):
I can only imagine the lobbying frenzy that's going on
right now in DC given this as a topic of
conversation with reconciliation.

Speaker 4 (11:55):
It's absolutely incredible.

Speaker 1 (11:56):
Let me give you another just a quick fact here
that really surprised me when I discovered.

Speaker 2 (12:03):
It a couple of months ago, and.

Speaker 1 (12:05):
That is is that the highest compensated healthcare insurance CEO
in the country is a Medicaid managed care provider. He
covers Medicaid recipients. Eighty eight percent of his beneficiaries are
on Medicaid, the rest are on the other twelve percent
are either on Obamacare subsidized plans or Medicare advantage plan.

(12:26):
They cover about five point two million people in America.
This is the highest compensated health insurance CEO in the country.
And you know, like I don't you want to speak
for other people, but I personally believe that, you know,
we shouldn't be creating a system where you can get
rich off of providing.

Speaker 2 (12:45):
Welfare to people, right.

Speaker 4 (12:46):
I think that that's wrong and also one.

Speaker 1 (12:50):
In which one hundred percent of your revenue is connected
to the federal government. Right, Like we should, you know,
we should have a better profit motive for people who
could make money by actually improving people's lives and making
them healthier.

Speaker 3 (13:04):
Amen to that sounds like a lot of the problems
we're have with non governmental organizations just generally speaking. I mean,
they exist to create jobs for the people that work
within the organizations and taking federal taxpayer dollars and really
I think going out into the world and literally accomplishing
nothing except perhaps letting the money loop back a little
bit to line the pockets and politicians in DC.

Speaker 2 (13:23):
BINGO. I mean, that's exactly right.

Speaker 1 (13:25):
And you know, one of the things actually, you know,
that we've been talking to some of the members of
COMMRESCE about is that there's pretty good data on how
when you expand Medicaid and other welfare programs, democratic turnout
in democratic counties goes up. And the reason for that
is because the healthcare industrial and welfare industrial complex uses

(13:50):
these NGOs that are that are that are far left
in many cases, like planned parenthood and others to help
them enroll people. And then and that gives those same
NGO's access to you know, names and addresses, which allows
them to go out and and increase turnout right and into.

Speaker 4 (14:09):
Put into boot harvest and uh. And so you know,
by by expanding.

Speaker 1 (14:14):
The welfare state, not only are we creating a culture
of dependency, but we're also creating a culture that feeds
one party, one political party over the other.

Speaker 4 (14:25):
And that's intentional.

Speaker 1 (14:26):
They that's they they know that that's what they're doing.

Speaker 3 (14:31):
We are you didn't you didn't come looking for an
argument today, doctor Paul Winfrey. Unbelievable, so so revealing and
so nefarious. If I can boil down this entire concept
of what's gone on, what's what's unfolded over the years
with Medicaid, EPIC, ep I CE, epic for America dot org.
Really valuable website you've got going there and the work
that you're doing there is just is so important.

Speaker 2 (14:51):
Doctor.

Speaker 3 (14:52):
Thank you so much for spending time with my listeners
and enlightening them and me on the how bad this
is out there. And let's keep our fingers crossed and
we do get some reform paths, because this is a
this is a sinking ship round. This is just one
part of the of the budget and clearly we have
outspent ourselves to a degree that I think it's an
existential threat to our existence as a country.

Speaker 4 (15:14):
Thank you very much for having me.

Speaker 2 (15:15):
I really appreciate it. It's been my pleasure, sir. Thank you.

Speaker 3 (15:18):
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