11x08 - Medicaid

[bunniefuu]

Welcome, welcome, welcome
to "Last Week Tonight"!

I'm John Oliver. Thank you so much
for joining us. It has been a busy week.

The White House hosted
the prime minister of Japan,

OJ Simpson d*ed,
may his memory be a blessing,

and South Korea held
parliamentary elections.

And if you've never seen South Korean
election coverage before,

they go all out with the graphics.

Only 300 seats are available
on the train,

and only one seat is available
for Gyeonggi-Hanam-gap.

Democratic Party Chu Mi-ae vs
People's Power Lee Yong.

Candidate Lee Yong is currently
in first place with 71.4% of the vote.

Will Ahn Cheol-soo's run continue?

Candidate Lee Kwang-jae enters
the race in Seongnam Bundang-gu.

Ahn Cheol-Soo, People's Power,
currently in first place with 62%.

This may be the first time I'm gonna
say this and actually mean it,

but, cool!

They used candidates in South Korea's
parliamentary elections to recreate

the climax of "Mission: Impossible:
Dead Reckoning Part One",

and they went big.

They even had a candidate
parachuting down toward the train

and kicking through a window,

and others flying around
with jet packs,

while still other themed coverage
had candidates collecting ballots

in buckets on their heads, all while
a giant faceless bear went surfing

and roamed the countryside, before
looming behind two presenters,

presumably figuring out which one
to eat first.

That is magnificent.
And what do we get here instead?

Steve Kornacki with his sleeves
rolled up touching a screen?

We're doing this wrong!
We're doing all of this wrong!

And while I would love to talk about
South Korean graphics all night,

sadly, we have to turn to Arizona.

Because this week, it did this.

The Arizona Supreme Court ruled today
that a near total abortion ban

on the books in Arizona since
the Civil w*r is enforceable.

Under the long-dormant 1864 law,
abortion is a felony.

Performing or assisting a woman
with having one

is punishable by imprisonment.

Now, all of that is horrifying,

including the fact that any kind of
medical procedure is being dictated

by a law from the 1800s,

an era when doctors prescribed
and this is true,

chloroform for asthma,
cocaine for hay fever,

and tobacco smoke enemas
for cholera.

And by the way, no, thank you.

I'll just go ahead and die from the
cholera if it's all the same to you.

The point is, it was clearly
a very different era back then,

as a CNN anchor tried, unnecessarily,
to explain to one of his guests.

You're a Republican strategist.

Do you really want states going back
to Civil w*r-era laws

on reproductive freedom?

Women didn't even have
the right to vote at that point.

This sounds like kryptonite.

This sounds toxic for Republicans
across the country.

Jim, I don't want states going back
to pre-Civil w*r on any issue,

for obvious reasons here, right?

Point taken.

Yeah, I hope the point is taken!

I love the cluelessness of looking
at a Black man and saying

that the 1860s were bad because
women didn't have the right to vote.

I mean, it's true, but also,

maybe not the worst thing people
didn't have the right to do back then.

But it's worth taking a moment
on just how arcane this law really is.

It was written as part of the first set
of the laws for the Arizona territory,

which also legalized consensual sex
with a 10-year-old,

and spelled out the crime
of "excusable homicide",

which included situations like
when death occurs

while "a parent is moderately
correcting his child".

So, just to recap 19th-century Arizona
law… Abort a fetus? Felony.

Sleep with a fifth-grader? Fine.

m*rder your child for pissing you off?
That's okay,

as long as you are moderate
and don't make it into a whole thing.

It's unclear exactly when Arizona's
abortion ban will go into effect.

What is clear, though,
is that this is not something

the majority of Arizona citizens wants,

as polls two years ago showed 62%
of voters there backed

making abortion legal.

The current rising anger is why many
Republicans are now frantically trying

to distance themselves from this law,
including Kari Lake

current Senate candidate and possessor
of big "local real estate agent" energy.

She said this week
that she opposed the ruling.

And I guess that would carry
some weight,

except for the fact that she did
an interview two years ago

in which she not only expressed
support for the law,

she even specifically
cited its number.

I'm incredibly thrilled that
we are going to have a great law

that's already on the books.
I believe it's ARS 13-3603.

So it will prohibit abortion in Arizona
except to save the life of a mother.

Look, if you're gonna backtrack
on an issue,

at least double-check you haven't said
the exact opposite into a microphone

for something called
"The Conservative Circus".

Which I know sounds like a phrase
MSNBC would try to use

as a sick burn
for Tr*mp's motorcade or whatever,

but it's actually
just some guy's podcast.

But it's gonna be hard for state
Republicans to distance themselves

from all of this.

Because just before Roe
was struck down,

the state legislature actually passed
a bill which explicitly affirmed

the validity of the 1864 ban.

So, they knew that as soon as Roe
was overturned,

that ban was likely to become law.

And yet, a state senator who voted
for that bill, Shawnna Bolick,

was quick to call for a repeal
of the abortion ban this week.

Which would already be hard to take,

before you learn that her husband
is actually

one of the state supreme court
justices who voted to revive it.

And while it's not strictly relevant,

you should know that he also
once did this.

An Arizona supreme court justice
accused of racism

after an old video surfaces
on social media.

Justice Clint Bolick is seen
singing to a crowd wearing a wig

with dreadlocks and calling himself
"Rasta Clint".

And I don't like tyranny.

So, I fight for freedom, freedom,
freedom, all the long day.

Okay. Hard to hear "freedom, freedom,
freedom" from that man

in any circumstances,
but especially this one.

Now, he justified that by saying,
"I am a fan of reggae music",

something very much
not on display there.

To be honest, with his injured arm,
he looks less like a reggae musician

and more like he's starring in a r*cist
community theater production

of "Dear Evan Hansen".

But Shawnna Bolick isn't
the only lawmaker backpedaling,

another state senator who voted
for that bill, T.J. Shope,

justified his vote this week like this.

I don't know that any of us
really actually believed

that Roe v. Wade was going
to be overturned.

So, it was definitely more of a
theoretical, I guess, than an actual.

So, you vote a certain way.
I have no regrets.

You vote a certain way based on the
information that you have at the time.

Yeah, but you had all the information
at the time.

The law was literally passed in
anticipation of the overturn of Roe,

so that is bullshit. But I do get
that he's in a quandary there.

Imagine having a problem that started
out as theoretical

and suddenly became actual,
even if you didn't really want it to.

That could completely f*ck up
your whole life, couldn't it?

If only there were some
obvious parallel

that we could use to illustrate
how frustrating that would be!

This Arizona decision is so toxic,

even Donald Tr*mp this week knew
enough to try and condemn it.

Did Arizona go too far?

Yeah, they did.
And that'll be straightened out.

And as you know,
it's all about states' rights.

I'm sure that the governor
is going to bring it back

to reason and that'll be taken care
of, I think, very quickly.

Okay, there's a lot to hate there,

from blaming Arizona for a mess
that he largely created,

to invoking "states' rights",

a phrase famously associated
with peaceful compromise.

But despite Tr*mp's
reassurances there,

the Arizona legislature had the chance
to repeal the ban on Thursday morning,

and they chose to adjourn
without taking any action.

And that is the thing,
Republicans own this.

They got what they wanted,
overturned Roe v. Wade,

and now they have to deal
with the consequences of that.

Which hopefully will be
rightfully furious constituents

turning them out of office.

Because everyone we've mentioned
tonight is on the ballot in November,

even "Rasta Clint",

And Arizona is also likely to have a
referendum on abortion rights then, too.

So Arizonans have just seven months
to ensure their voices get heard.

And by the way, cable news?

That means that you also have seven
months to make sure that,

come election time, your graphics
are up to the task.

Because the bar has been f*cking
raised on that. And now, this.

And Now: People on TV Are Kind
of Being Dicks to Cicadas.

It's the return of some very old,
creepy, crawly, noisy insects.

The massive invasion of these guys.

- Oh, God.
- It's that time.

Oh, no!

Your thoughts on the cicadas?

They're annoying.

They're annoying. They're loud.

They are disgusting to look at.

- Those things just gross me out.
- I hate the noise.

The noise they make.

- Get that thing off the screen.
- Ew, it's ugly.

They're really ugly looking.

Beady-eyed, noisy bugs.

- Six-legged, winged horrors.
- Yeah, they're kind of gross.

And they stink to high heaven.

Let's send those cicadas to the moon.

But don't you worry, after May,

these bugs will die and disappear
again for another 13 years.

- They're annoying.
- Disgusting to look at.

- Beady-eyed.
- They're really ugly.

They stink to high heaven.

Let's send those cicadas to the moon.

Moving on. Our main story tonight
concerns healthcare.

The industry that's done basically
no innovating in the past 50 years

when it comes to big rolls of paper
you plop your bare ass on.

Specifically, we're gonna
be talking about Medicaid,

the public insurance program that
provides health coverage to people

with low incomes.

It is massive, representing one out
of every $6 spent on healthcare

in the U.S.,
and as of last year, at least,

it covered more
than 90 million people.

And the reason I put that in the past
tense is, thanks to something called

the Medicaid unwinding, that number
has been plummeting, and fast.

Hundreds of thousands of Americans
are finding out

they may be without all-important
Medicaid coverage.

It's a process they're calling
Medicaid unwinding.

They basically said, "Hey, sorry,
you don't have insurance."

They didn't even tell me that
I was dropped.

We have people that we have served
for 15 to 20 years,

and suddenly they're dropped off
Medicaid.

It's true, people have been getting
kicked off Medicaid,

and sometimes with no notice.

In the last year, net enrollment has
dropped by over 11 million individuals,

including nearly five million children.

And just for once,

could the government blindside
people with something beneficial?

Or even just fun?

Like if one day Congress announced
they'd be adding Shrek

to Mount Rushmore?
That would be something!

He'd fit in so naturally, you may not
even have noticed, he's in there!

Mount Rushmore is better
with Shrek on it!

And the thing is, all of this was,
to some extent, by design.

The unwinding has its origins
during the pandemic.

Because when Covid started,
one early relief bill had a requirement

that states couldn't kick people off
Medicaid.

Which was a good idea, given there was
a giant, global public health emergency

and millions of people were losing
work and getting sick.

But at the end of last March,
that policy expired,

and for the first time in three years,

states started checking people's
Medicaid eligibility again.

Some states, like Georgia, even tried
putting out PSAs like this one,

to alert people to the changes
that were coming.

Hey! Did you know there may
be some big changes coming

to your Medicaid coverage?

You're a talking peach.

Sure am! But that's not important
right now.

What's important is that you visit
stay-covered-dot-GA-dot-gov

and update your contact information.

Why?

Well, the federal public health
emergency may be ending soon,

so it's important that you verify and
update your Medicaid account.

Thank you, Mr. Peachy.

Oh, no, that's my brother.
I'm George.

It's excellent.
I mean, it's all very good,

but my favorite part is the shopper
saying, "You're a talking peach,"

and it responding, "Sure am,
but that's not important right now."

Uh, disagree, talking peach!
You're a piece of fruit that can talk.

That is maybe the most significant
event in the history of humanity

or fruit.

If that were to happen,

every government would have to rethink
their farming policies immediately.

The UN would hold an emergency
assembly regarding

the "talking peach" issue.

And how could anyone ever be
comfortable eating fruit again,

knowing that at any moment,
it could go suddenly,

"Ow! Stop it, you're hurting me!"

Now, unfortunately, despite
magnificent PSAs like that,

not everyone heard
about the Medicaid unwinding,

or knew exactly what they had
to do to keep their healthcare.

And what that has meant is that a
process that was theoretically

just about removing people
who no longer qualified,

has in many states turned into
an administrative clusterfuck.

Because 69% of those who lost
coverage had it terminated

for procedural reasons,
like missing paperwork,

with that number climbing as high
as 93% in states like Nevada

and New Mexico.

That means the overwhelming majority
weren't necessarily ineligible.

They might've been, their
circumstances might've changed.

But most lost coverage because,
for one reason or another,

they, or their parent or guardian,
never completed the renewal process.

And for many, that wasn't their fault,
but the state's.

Take this Florida family,
who received zero notice

that they had to do anything to maintain
their Medicaid coverage,

then suddenly found that they'd lost it
at the worst possible time.

The past 24 hours have been
a nightmare for Liz Adams.

In that time, she found out her two kids
were dropped from Medicaid.

The news also came a day before
her seven-year-old son, Brian,

was set to have a biopsy procedure.

He's currently in remission
for leukemia.

I'm mad. I am mad.

I do not understand how
they can do this to a child.

Adams tells us she never got a letter,

a call, or any other form
of communication from DCF.

No one else I can talk to, not even
the doctor's offices can do anything.

They're like, "We can tell them that
it's absolutely necessary

that he needs medical treatment,

but we can't make them give
you your insurance back."

That is terrible.
Because anyone could tell you

that kid needs medical treatment.

I could tell you that.
A Magic 8 Ball could tell you that.

That octopus that used to predict
soccer matches could tell you.

If you put out two pieces of food, each
labeled with an option of what to do,

it would ignore them both and write
in the sand,

"What the f*ck is wrong with you?
Give the kid Medicaid, you monsters."

But the thing is, everything about the
current unwinding is emblematic

of much larger issues with how
we've always administered Medicaid.

So, given that, tonight, let's talk
about Medicaid in general.

It was first enacted in 1965 as part
of the same law that created Medicare,

the program providing healthcare
to the elderly.

And from the start,
it was set up very differently.

Because while Medicare
is a purely federal program,

open primarily to Americans 65
and older,

Medicaid is a partnership between the
federal government and the states,

where the federal government
contributes at least $1

in matching funds
for every dollar a state spends.

And while there are some federal
requirements states must meet,

they get a lot of leeway in deciding
how to run their programs.

And when done well, the services
they provide can be transformative,

for instance, Medicaid can pay
for people with disabilities to have

home health workers come and help
with mobility and daily living.

Which is huge, as this activist
pointed out a few years ago,

when cuts to Medicaid spending
were being floated.

Medicaid paid for my shower today,
made it so I was able to eat breakfast,

helped me put on my clothes.

I breathe because of Medicaid,
my ventilator.

I move through the world because
of a wheelchair funded by Medicaid.

Medicaid touches everything in my life.
It makes everything possible.

Exactly. When Medicaid works,
it can be amazing.

Unfortunately,
it often doesn't work that way,

which you can probably guess by the
fact that we're talking about it now.

If this show was supposed
to make you feel good,

it wouldn't be hosted by me,
it'd be hosted by Stanley Tucci.

You'd be watching an impossibly
horny 30-minute deep dive

on negronis right now.
That's a better show.

I wish this were that show.
You wish this were that show.

But guys, I'm sorry, it just isn't.

The thing is, not all states offer care
like that, or make it easy to get.

But there's actually an even bigger
problem here, which is that in general,

even for those who qualify
for Medicaid,

it can be incredibly difficult
to access.

And the problems begin with
basic administrative f*ck-ups,

like what happened
to this one-year-old in Florida.

Raven received a Medicaid health
insurance card, which, by the way,

has her correct date of birth on it.

But the state kept rejecting it when
her doctor tried to run it

on grounds she's not yet born.

She is not born.

She is 13 months old, alive,
but she is not born.

She is still apparently a fetus
in my womb.

So, I just pray she doesn't get hurt
or doesn't get severely sick

because I'm out of luck.

They've got copies of her birth
certificate, her Social Security card,

everything to prove she was born,
including being physically there.

That family actually went $2,000
into debt paying for routine care

for their child, while the state tried
to figure out if she existed or not.

Which is ridiculous. If you want
to know if someone was born,

here is a quick trick: just ask,
"Were you born?"

If they say, "Yes," they were born.
If they say, "No," they were born.

And if they just stare blankly at you,
they were also born.

I've made this into a decision tree,

but it really doesn't feel like that
should have been f*cking necessary.

For years, people trying to access
Medicaid in their state have had

to navigate through
poorly designed websites,

long wait times, and complex forms
and notices.

And those burdens have had
a real effect.

Even before the chaos
of the unwinding, in 2022,

about a quarter of uninsured people
eligible for Medicaid

were not enrolled in it,
often due to enrollment barriers.

And the thing about Medicaid is,

you don't just have to go
through that circus once.

You have to renew your coverage
every year,

which can be incredibly onerous.

At one point, Tennessee was sending
families who wanted to renew

their Medicaid a questionnaire
that could be as long as 47 pages,

and the state could be pretty
careless about doing that,

as one family lost coverage after their
renewal packet was accidentally mailed

to a horse pasture.

Which is obviously absurd, because
horses aren't eligible for Medicaid.

They get healthcare through
a very different program,

called the glue factory.
We all know this.

And look, glitches can occur
in any system.

And they can happen more often
in government programs,

which tend to be underfunded,
understaffed,

and operating on ancient technology.

And I'm not trying to rain sh*t down
on honest government employees

who have to process an endless
barrage of paperwork.

I have total sympathy for how
demanding those jobs are.

In fact, there's exactly one group of
government employees that it's okay

to make fun of for something
that is not their fault,

and that is Secret Service agents,

for the fact they are constantly
being bitten by the president's dog.

I'm sorry, I hope they're all fine,

but I'm still gonna laugh every time
I think about that.

But there are times when it feels like
the obstacles to getting Medicaid

have been put there deliberately,

so the states can keep those that
they see as undeserving off the rolls.

Because states get a lot of discretion
in deciding who is,

and isn't, eligible for benefits.

And in some, they keep the bar
to qualify troublingly high,

all while adopting
a deeply moralizing tone.

Take what happened when the Tr*mp
administration gave some states

permission to implement work
requirements as a condition

of Medicaid eligibility.

Some were eager to put those into
place, like this state rep in Kentucky.

Why do you think the work
requirements are going to work?

It's an incentive.

I think that there is dignity in work.
It's something that is about

the human person.

So, often I say that our sometimes
our charity becomes toxic to people.

In our wanting to help them,
sometimes we've hurt them.

Putting aside that calling access
to basic healthcare "charity"

is immediately infuriating,

"it is something
that's about the human person?"

Are you absolutely sure
that's a sentence?

'Cause it sounds more like something
a drunk alien would say

while trying to describe
a David Foster Wallace book.

"It's something that's about
the human person.

You know, the humanoids,
and their person feelings."

But it's worth noting that the majority
of adults on Medicaid,

about 63%, are already working
full or part-time.

Those who aren't are generally
in school

or might have a disability
preventing them from working,

only leaving a very small percentage
of the population to whom

the policies could even apply.
Now, fortunately,

Kentucky didn't end up implementing
a work requirement.

But unfortunately, Arkansas did.
And it didn't go great.

For a start, simply complying
with it was a hassle.

Beneficiaries had to report
their work activities

on a glitch-plagued web portal,
and just six months in,


of Medicaid

and locked out of reapplication
until the following year.

And for some of those people,
who, again, were already working,

losing access to healthcare completely
upended their lives.

Like this man, who had a job
at a chicken plant.

Adrian McGonigal's life
is coming undone.

He became one of the people that the
state has booted from the Medicaid rolls

in the last three months.

He discovered this only when he went
to fill prescriptions

at this drug store,
and the pharmacist told him,

"Sorry, your coverage has been
canceled."

And that it was going to be like $340
for one of the medications,

and like $80 for the other one.

So, he left empty-handed.

This was a big deal, because
McGonigal has severe COPD,

a chronic lung disease
that makes it difficult to breathe.

Without his meds, he landed
in the hospital multiple times

and missed a lot of work.

His supervisor tried
to accommodate him,

but he wasn't healthy enough
to perform his job. So, he lost it.

The work requirement for Medicaid
caused someone who was already

on Medicaid and working to lose
both Medicaid and their work.

Which has to be the most upsetting
thing that's ever happened

in a chicken processing plant,

apart from all the other things
that happen in there on purpose.

And while Arkansas ditched that work
requirement after less than a year,

Georgia is now experimenting with one,

and it is proving just as stupid
and just as frustrating.

That is the thing: so much of the talk
around Medicaid seems to center

on the fear that someone, somewhere,
might be gaming the system.

You hear
that argument all the time.

The people in my district
that work hard,

that struggle to pay their healthcare,
they're very frustrated

when they see someone they know
in their small town,

where everybody knows everybody,
they see someone that's not working.

Why should somebody have to go
to work every day and pay taxes

to provide something to someone
who could do the same thing

but chooses not to?

And I don't think it's unreasonable
to say that able-bodied people

who are working age,
who are not disabled,

who are not seniors should
have to go to work

if they want someone else to pay
for their healthcare.

Look, it goes without saying that
I disagree with Matt Gaetz

on a lot of issues,

his stance on immigration,
his stance on g*n control,

his stance on hanging around
with teenage girls.

We don't see eye to eye
on most things.

But on this, I particularly disagree.

Because states already aggressively
monitor Medicaid eligibility,

and some of their efforts can be
deranged. Take Tennessee.

Their state inspector general
has a Medicaid fraud unit

that posts the names and photos
of people it arrests

on a government website
and social media,

with some even ending up
on a most-wanted list.

This woman was charged with a felony
for supposedly receiving

Tennessee benefits while living
in Mississippi,

and wound up having to pay
$2,000 to bond out of jail

and even more to hire an attorney,

all just to show that she'd not,
in fact, committed Medicaid fraud.

Her driver's license just had
an outdated Mississippi address.

Sher only real crime there was not
wanting to stand in line at the DMV

for eight solid hours.

The head of that Tennessee unit
even acknowledged it costs far more

to run the fraud unit than the office
will ever recoup from people

on Medicaid,
who are usually low-income.

Because "even if the state recovered
every dollar from charges

brought against beneficiaries in 2022,

the total would amount to less
than $900,000,

compared to the office's budget
of $6.4 million a year".

I'm not an accountant, despite having
resting "budget analyst" face.

But even I know that makes
no financial sense.

I'm not saying Medicaid fraud
doesn't exist. It does.

But for the most part, the costliest
fraud isn't being committed

by patients getting care they
may not technically be eligible for.

It's providers doing sh*t like this.

A husband and wife living a fairy
tale lifestyle, paid for by all of us.

Over a three-to-four-year period,
they were true jet-setters

in their private $900,000 plane.

The Harrons ran two health services
in North Carolina.

They billed the state's Medicaid
system at least $17 million.

Most, if not all, of the patients they
claimed to help were already dead,

their names gleaned from obituaries

and cross-checked
with the Medicaid database.

That is obviously reprehensible,

but if I could just give one quick
note to that news station,

everyone knows what dead people are.

You don't have to show B-roll
of a cemetery for us to understand

the concept of death.

Just like when you said the Harrons
ran two health services,

you didn't need to show stock footage
of a doctor writing something down

on a notepad.

But interestingly, you didn't do it
all the time, did you?

Like, when you said the phrase
"$17 million"

you didn't feel the need to show
this stock footage of cash

slowly falling out of the air.
But why not?

How else will your viewers
understand what money is?

As if all that weren't bad enough,

that guy liked to post his business
affirmations online,

including "never outlive
our usefulness",

"doing big things requires one not
to be stuck on the little things",

and "I'm not doing a business
that's new,

I'm doing a new way
of doing business,"

a quote he loved so much, he posted it
a second time a month later,

but in red text instead of yellow.

And I'll admit, it didn't really
resonate when I read

the yellow-text-over-dark-green
background version,

but once I saw the red-text-over
neon-green one,

I was like, "Wow, that is so true.
That's totally what he was doing."

But that is by no means the only case
of Medicaid providers

defrauding the government.

In Arizona, there was a group of fake
rehab centers that, for years,

claimed fraudulent reimbursements
for patients

who were either getting services
they didn't need,

or not getting them at all,

reportedly taking in more
than $2 billion from the state.

And some of their submissions
really should've raised red flags,

like a bill for alcohol rehabilitation
for a four-year-old.

Which is a little difficult to believe.

If toddler alcoholism were
a genuine problem in this country,

you'd have definitely seen
a TLC series about that.

You know that is true, and you'd
probably have watched it.

And while, in both of those cases,
the providers were eventually caught,

it took years for that to happen.

Again and again, the priority seems
to be making

sure no individual gets a penny more
healthcare than they "deserve,"

even as states are weirdly blithe
about much bigger amounts of money

flowing out the door to large
organizations.

And speaking of large organizations,
there is one last,

massive flaw with our Medicaid system.

And it has to do with Managed
Care Organizations, or MCOs.

These are private companies
states contract to deliver

and pay for healthcare.

Currently, 72% of Medicaid beneficiaries
are enrolled in a care plan overseen

by an MCO. And it is big business.

The five biggest MCOs are on
the Fortune 500,

including Centene, which has long
been a favorite of this guy.

Centene! Yeah, a healthcare
plan provider

for government-sponsored programs
like Medicare, Medicaid.

This one's a longtime Cramer favorite,

but Michael Neidorff tells such
a compelling story.

Michael Neidorff, Centene,
what a horse that thing is.

You have impressed me over
the years as someone

who is really out for the consumer
to get the best healthcare.

You have Michael Neidorff on
all the time. No, Centene.

I think that Michael Neidorff
is amazing.

By the way, he looks great for 77

He's amazing and he's just also
a fantastic, charitable man.

Okay, you probably already knew
Cramer's wrong about the company,

but before we even get to that,
I'll point out that the guy

they just said looked "great for 77"
was actually 79

and, more importantly d*ed
just four months later.

It seems any optimistic prediction
that Jim Cramer's involved with

is enough to k*ll a business
or even a person.

Seeing him compliment you on TV
is the closest thing

we have to watching the tape
from "The Ring" in real life.

Now, as for Centene itself,
there are serious questions

about how it's made
some of its money.

In 2021, after Ohio sued it
for overbilling Medicaid,

it settled, and paid the state
$88 million.

In fact, it's now settled allegations
of overbilling in at least 19 states,

for nearly a billion.

And I would argue that
if you've had to do that,

you may not deserve to exist
as a company anymore,

let alone have Wall Street's thirstiest
business boy go

"hubba hubba, awooga"
over your stock price.

And look, financial damage
is one thing.

But the most infuriating thing
about MCOs is that,

as with so many players in our
for-profit healthcare system,

they are incentivized to cut costs
at the expense of necessary care.

Because MCOs get paid a set monthly
amount per person,

meaning they get a fixed rate.

So, their profit is whatever
they don't spend on patients.

And you can probably see
where this is going.

In state after state, there've been
heartbreaking stories

of MCOs denying care and prioritizing
cost savings over patients.

There've been headlines about this
in Florida, Texas and Iowa.

And just to focus on Iowa,

it transitioned to using MCOs to run
its Medicaid program in 2016,

and in just its first three years,
there was a nearly 900% increase

in members being illegally denied
services or care.

And some of the cost-cutting
was absolutely enraging,

like what happened
with Louis Facenda,

who has cerebral palsy
and was living with his mother.

He needs a lot of care,
which prior to the switch-over,

was provided by Medicaid.

But once an MCO got involved,

he lost a lot of what he'd been getting,
starting with his medications.

It was a nightmare.
It was literally a nightmare.

What am I gonna do?
I can't afford all that medication.

Also cut were his daily nurse visits.
So, for six weeks,

Louis went without the in-home
bathing and diaper changing

he had had for years.

He wasn't getting changed like
he would normally get changed

two or three times or more a day.

It wasn't just the services, it was
the mental part of his state of mind,

not understanding why
all this was happening.

Look, that's obviously maddening.

And it doesn't get any better when
you hear a doctor at AmeriHealth,

the MCO that took over in Iowa,

explaining in a hearing
about a similar patient

just what the corporate thinking
was about the necessity

of keeping people clean.

People have bowel movements
every day

where they don't completely clean
themselves,

and we don't fuss over too much.

People are allowed to be dirty.

You know, I would allow him to be
a little dirty for a couple of days.

Look, I'll be honest.
When I first heard that, I thought,

"That has to be taken out of context.

There is no way a doctor, a licensed
physician, would testify, in a hearing,

that he thinks it's okay if people
have sh*t on them for days."

So we got the full hearing,
and I'm not going to play it for you,

I'm just going to tell you, he said it,

he meant it, and it made me want
to punch a hole in the wall.

And just watch what happens when
Louis and his mom were told

about what that doctor just said.

What would you say to him
if he was here?

I would spit in his face, to be honest.

Yeah. Right, Louis?
You like to be clean.

I think it's horrible.
I don't have words for that.

I'm kind of struggling for words, too.

Although Louis did kind of nail
it there by blowing that raspberry.

And I also appreciated that reporter
doing a full Jim from The Office

look to camera and nodding.

But if I absolutely had to put it
into words,

I guess I'd say, f*ck that doctor
with a rusty canoe,

I hope he gets tetanus of the balls.

And if he has a problem
with my language there,

I'd say, I'm allowed to be dirty.

People are allowed to be
a little dirty sometimes.

Apparently that's
doctor's f*cking orders.

And while, legally, I have to tell you,

AmeriHealth eventually restored
Louis' service,

it is a disgrace
it was even a fight to begin with.

Look, the reality of Medicaid is that
too often, it's hard to get,

easy to lose, and not a priority
for the government,

or the companies we hire to deliver
care. So what can we do?

Well, as I've said before, I personally
think the big solution here

is to adopt a universal
healthcare model.

But in the meantime, I'd argue both
the current unwinding,

and Medicaid programs in general
need to be run

with significantly more care
and efficiency.

And there are ways to do that.

For instance, when it comes
to determining eligibility,

maybe rather than sending


states could instead rely on information
they already have in their databases.

That seems like it would make
a bit more sense.

And Michigan is actually
a good example here.

It worked with a design nonprofit
to retool its application

and renewal processes
for all public benefits,

and the result was that 95%
of renewals were submitted on time,

with a 60% drop in user errors.

On the federal end, Congress could
ensure that the agency

that administers Medicaid
has the resources it needs

to oversee state compliance.

And finally, when it comes to MCOs,

if they're going to continue playing
a role here,

there clearly has to be
way more oversight,

with performance reviews being
thorough and public,

especially when it comes
to things like denials of care.

And until such time
as we do all of that,

the very least we can do is make
Medicaid PSAs that prepare people

for the realities
of our current mess of a system.

Hey! Did you know you might
be eligible for Medicaid?

You're a talking peach.

Sure am!
But that's not important right now.

What do you mean? You can talk?
Could all peaches always talk?

Sure, we could.
But don't focus on that.

Because I want to talk to you
about Medicaid.

Is anyone else seeing this talking
peach?

I see it, too, Mommy.

The process of getting on Medicaid is
different depending on where you live.

The good news is that pretty much
in all states,

generally, low-income children,
pregnant women and families,

and people with disabilities
are eligible for Medicaid!

With some exceptions.

Are there going to be a bunch
of bullshit loopholes or something?

You have no idea.

Well, he's right!
Take my state, Texas.

Oh, my God. There's more of you.

Momma, what is that thing?

Well, I'm a sweet potato.

Now, let's say you're a single mom
with two kids.

If you're making over $334 a month,

you're not eligible for Medicaid at all.

It's true! And in Georgia,
if you don't have kids,

you better be working! Otherwise,
you can't get Medicaid.

Ay, good for you! You're not running
a charity over there.

There's dignity in work. It's something
about the human person.

Yeah, I agree!

Hey, y'all! I'm from Louisiana.

Mom, what's up with this one's eyes?

Yeah, this one's got wrong eyes.

In my state, we check your finances
every three months

to make sure you haven't gotten
some overtime

or picked up some seasonal work
or nothing.

Guess what! In Wyoming,

if you're an adult without kids or
disabilities or a pregnancy,

you can't qualify for Medicaid at all!

No matter what your income is.

There's literally
no way to qualify for it.

Oh, my Lord. Is that true?

Even if you're, like, out of work
and, like, making no money?

- Yes!
- Honestly, that's f*cked up.

It is f*cked up.

I agree with the coconut.
That's super f*cked up.

Mommy, I'm scared.

I know, buddy. Come over here. Stand
on this side away from the produce.

That's a cute kid you got there!

Thanks.

Don't worry, his Medicaid coverage
won't be cut.

I smell more bullshit loopholes.

Unless you don't fill out
the proper paperwork.

But also, maybe if you do, but there's
a glitch in the system,

like, I don't know, us mailing your form
to a horse pasture.

Oh, it's happened, y'all.

Hey, how do we know your kid was
really, you know, born, anyway?

Excuse me?

Yeah, if that kid wasn't born,
then he doesn't get Medicaid.

Prove he was born!

Prove he was born!

Was I born?

- Stop it!
- Prove he was born!

I don't have to prove anything
to you! You're vegetables!

The child is the proof!

Listen, I know this is all complicated.

So, feel free to just give your state
Medicaid office a call

if you have any questions.

Be patient, though. In Florida,

it takes more than an hour to get
a live person on the phone.

No way, dude.

Also, there's about an 80% chance
your call will disconnect by accident.

I don't speak Spanish.

He said there's an 80% chance
your call will disconnect by accident.

What's the point of even calling then?

Because it's a fun thing to do.

I agree with that.

Okay, we're leaving now.
Thank you, Mr. Peachy.

Oh, Mr. Peachy is my brother.
And you ate him last week.

- What?
- And now, we're gonna eat you.

Aw, sh*t.

That's our show, thanks so much for
watching, we'll see you next week.

Por favor, excuse me.
Hi, hello. Can you help, please?

Yes, can you remove this tomatillo
husk from my eye?

It's hanging down. It's hanging over.

Please.
I'd like to see with both eyes.

Por favor. I don't have hands. Please.

Gracias. Thank you for doing that.