Mostert: Medicare/Medicaid fraud means fewer resources for people with disabilities

While Americans with disabilities are better supported and included in society than ever before, they still face significant challenges to lead productive and happy lives. Almost everyone has a “disability story” about themselves, their families or their friends and acquaintances.

This does not necessarily mean that we know the defining characteristics of the disability community and what is needed to support them effectively. A recent fact sheet from the Centers for Disease Control and Prevention uncovers the stark divide between Americans who experience disabilities and those who do not.

First, more than a quarter of the U.S. population (28.7%) have some form of identifiable disability. This means 61 million people. If immediate caregivers are added, there are 100 million U.S. citizens intimately connected to disability. That’s no small number.

Second, health outcomes unrelated to people’s disability characteristics often lag behind the rest of the population. People with disabilities are more likely to be obese (40.5% vs. 30.3%). They are more than twice as likely to smoke (20.9% vs. 10.2%), have heart disease (10.4% vs. 3.7%) and have diabetes (16.6% vs. 7.9%). 

This means that irrespective of their disability characteristics, which in and of themselves often present medically mild to severe issues, many in the disability community face an uphill battle to stay healthy aside from the medical problems their disability might cause. They are, in fact, doubly disabled.

Third, these statistics make access to quality medical care all the more compelling. However, here, the scenario is equally alarming: For adults with disabilities aged 18-44,  has remained unaddressed because of the cost of medical care.

Furthermore, among people with disabilities aged 45 to 64, 17% have not had a routine medical check-up in the last 12 months. This lack of engagement with medical professionals increases the likelihood of exacerbating health problems, which, in turn, become more difficult and expensive to address.

The CDC recommends several general but vague recommendations, such as building inclusive health programs, improving access to healthcare, promoting healthy living, monitoring public health data, and researching and reducing health disparities.

Unfortunately, these recommendations are hardly groundbreaking.

Millions of tax dollars have already, over many years, been allotted for similar recommendations without much apparent effect. It makes little sense to re-recommend that obvious but partial solutions that have not worked. Irrespective, the CDC will likely recommend more money be poured into these nebulous quasi-solutions, with the predictable effect of not working again.

The idea of throwing more money after vague recommendations is sobering considering two other factors, namely, the amount of money already spent on medical care for people with disabilities and the massive amounts of waste and fraud among agencies serving the disability community.

For example, in terms of the vast sums of money already spent, the Centers for Medicare and Medicaid report that for 2022, national health expenditure grew to $4.5 trillion ($13,493 per person, 17.3% of Gross Domestic Product). Medicare spending rose 5.9 percent to $944.3 billion in 2022, and Medicaid spending grew 9.6 percent to $805.7 billion. More money does not necessarily translate into more efficient and effective services for people with disabilities.

Waste and fraud mean fewer dollars get to the people who need them most. The Department of Health and Human Services inspector general reported that for 2023, Medicare and Medicaid made improper payments of $101.4 billion because of overpayment, upcoding, misdirected payments and fraud. Many believe this waste is a markedly greater problem than reported. Recovering this money is arduous and does not recoup anywhere near the amounts wasted and stolen.

Clearly, the disability community loses out when billions meant to support them disappear.

Can this state of affairs be remedied? Possibly, but historically, this has not been the case. Medicare and Medicaid are massive bureaucratic entities that are sclerotic and unfocused.

It is beyond time to consider whether Medicare and Medicaid should be radically reformed to better meet market demands. Instead, it’s time to consider whether the private sector can do a better job for people with disabilities and their families.

Editor’s note: Mark P. Mostert is a senior researcher at Able Americans, a National Center for Public Policy Research effort to support people with intellectual, developmental and physical disabilities. Reader reactions, pro or con, are welcomed at AzOpinions@iniusa.org.