THE ATLANTIC has an article about "Medicaid's Dark Secret: For many participants the program that provides health care to millions of low-income Americans isn't free. It's a loan. And the government expects to be repaid," by Rachel Corbett, 10/2019.
The article details the estate recovery process imposed by MassHealth and the loss of inherited assets for one family after an elderly family member's stay in a nursing home and ultimate death. What the survivors got was a lien placed on the home and a bill. Noteworthy, the individual was only in a nursing home for a short period of time.
While Medicaid always included the option for state recovery, a few things were different in prior times, which the article omits. The article focuses on the 1993 Deficit Reduction Act under Democrat Bill Clinton which MANDATED that states go after estate recovery where deceased Medicaid recipients were over the age of 55. This was possible because of the control the federal government has over states with its sharing the funding of state programs.
The article omits that the endlessly and without limit rising costs of health services and medications that has also contributed to this crisis in the ability to pay for needed medical care, expanding the need for individuals with assets like houses to apply for Medicaid, as well as, the expanded pool of untapped assets of the baby boomers that is as alluring to the government as the next even bigger generation of millennial assets will be. Finally, the eased eligibility for Medicaid has also made room for states to expand when and how and what they'll collect from individuals receiving Medicaid.
Under Obamacare, with its long-boasted reliance on the Massachusetts model, the same model at issue in the assets seizure case described in THE ATLANTIC and with Obamacare's expanded Medicaid, which not only enlarged the group of Medicaid eligible, but enlarged the federal government's "share" of paying for the program, the additional people on Medicaid mean more and more estate recovery will occur.
The article notes that "The majority of states…started allowing pre-death liens, tacking interest onto past-due debts, or limiting the number of hardship waivers granted." The Democrat law of 1993 also gave states "the option to expand their recovery efforts to include other medical expenses, and many did, collecting for every doctor’s visit, pharmaceutical drug, and surgery that Medicaid covered." (THE ATLANTIC, Rachel Corbett, October, 2019.
Some laws became harsher still not only going after transfers made of assets up to five years before Medicaid, not only going after homes of Medicaid recipients, but going after ALL assets, not just those going through probate but things like POD accounts and other accounts with named beneficiaries. As the article states, "At least three states passed legislation to scale back their recovery policies after public outcry."
In a conclusion that supports President Trump's Republican tax bill that capped property tax deductions at $10,000 (State and Local Tax, SALT) and limited the mortgage interest deduction to the amount paid on $750,000, though arguably Rachel Corbett would not think the law went far enough, Corbett states, "The mortgage-interest deduction alone—a set of housing subsidies that primarily benefits Americans in the top 20 percent of the income distribution—cost the federal government $66 billion in 2017. By comparison, letting every family of a Medicaid recipient keep their property would cost just $500 million, according to 2011 data gathered by the Office of the Inspector General, the most recent available."
Corbett goes on to describe that the subject of her article wonders whether Medicare for All would make Medicaid redundant avoiding the estate recovery provisions. Good question, but obvious answer. Medicare for All would more likely incorporate the money-grab of estate recovery than it would do away with it.
As Sanders gushes over Medicaid, and supports Medicaid UNTIL the new world of Medicare for All is phased in, it should be obvious that the costs to infinity program would incorporate the estate recovery provisions of Medicaid, and likely expand them in the same way they've been expanded before as the federal government looks to recoup its expenses.
The biggest indicators that Medicare for All will be worse for most consumers than what we have now is A) The relentless fact that public employees, like Congress, effectively exempt themselves from the provisions of Obamacare today and will exclude themselves from the provisions of Medicare for All tomorrow B) Democrats support Medicare and Medicaid and NEVER address the need to revoke the estate recovery provisions, made harsher by President Clinton in 1993 C) The number of people on Medicaid has gone up substantially, including a larger group of people who have assets, making a government grab of assets after death even more alluring for an over-spending Congress.
