The government has to admit that this is a failed experiment and a complete waste of money. They are worried about Part A insolvency? We know where to start.
I don't believe MA is a failed experiment. It was a handout to donors that was supposed to eventually get rid of Medicare and replace it with a privatized system.
It may have failed to completely replace Medicare.
is probably less than zero % of corporate welfare/tax payer dollars given to the private for-profit commercial health insurance industry & in turn agents & lobbyists. Horrible
With such anger and distraught among the bilked, it is no surprise, no matter how horrible, that an assassin became a folk hero. We need a total overhaul of Congress and bribed regulators. We need a universal healthcare one-payer plan for all. 75% of the people polled agree. And let’s be honest, the military budget has become unsustainable and needs to be cut in order to meet the nation’s essential daily needs.
They should be kicked out of all Federal programs! They knowingly committed fraud against the government, and paid a small fraction of that back. Wish we could get away with that... I thought that's what the law says in FWA.
I indicated yesterday, reasonably-on-topic, about the recently-made CMS claim that the full large amounts reductions, several millions and increasing, of the number covered by ACA on-exchange coverage, is fully due to the administration's successful crackdown and fraud, and is not due at all to the lapsing of the ACA expanded subsidies that the Republicans made happen 1/1/26.
I will not repeat that, but I feel that, since that claim, sure to be widely tossed about in the months before the midterms, is dependent of the rather-propagandistic term "phantom", sort of based on people who have ACA coverage but never file a claim, I feel it is important to immediately inform HEALTH CARE un-covered readers, who I believe tend to be very versed in the details of health insurance, that there is alternative terminology in use.
It seems to be geographical.
So, I have observed "ghost", which seems to be used or emphasized in certain locations, rather than "phantom".
is Republican Sen. Roger Marshall, of Kansas, using it. He says:
"Get this. 35 to 40% of Obamacare recipients that are enrolled in Obamacare never file a claim. Let me say that again. There’s 24 million people on Obamacare. 35-40% of those people never file a claim. These are ghost people. They don’t even know they’re on Obamacare."
I really don't know why the different term for the same thing. It causes confusion!
Sen. Marshall, certain coastal elites may have nastily asserted, changed “phantom” to “ghost” because he thinks most people in Kansas don’t know what the word “phantom” means.
(I have no opinion on the matter.)
I do just want to make sure Wendell Potter readers recognize both words, so they can be up on the policy debate.
(Perhaps, also, "Obamacare is haunted", if encountered, can be expected to really be the same claim.)
So let me get that straight - if I am enrolled in Obamacare and pay the premium but never file a claim (because I don't go to the doctor or don't get sick), I am a "ghost" or "phantom"?! Make that make sense.
Well, roughly, There's a little more to it than that. The Paragon Health Institute, and now CMS, is claiming that TOO MANY PEOPLE, particularly in the low-income under-150% FPL group, have been in the no-claim category, after people in that income zone, due to the expanded subsidies, have to pay no premium for the coverage.
The flaw is that, though looking consistent with a fraud explanation, that's also consistent with very-low income people, who are very healthy, getting the coverage only when it is free. Which could happen for multiple reasons in that group.
Possibly the fullest explanation of the multiple reasons (that I can think of) is within my second comment of the comment and reply to myself here, on Dean Baker today:
(For people with a little time on their hands, the right skills, and with sufficient interest, a fun activity could be to go through both the CMS report issued 6/26/26, and the Paragon Health Institute report issued earlier in June, and figure out what has gone on. That's what I did, and it was indeed fun!)
This response does not address my question. Whether one pays premium out of pocket or someone pays for him/her (in the form of subsidy) DOES NOT MEAN they are a phantom or a ghost. They are live people, luckily healthy enough to not file a claim but enrolling in insurance in order to be covered IN THE EVENT THEY GET SICK. That’s how generally insurance works. If someone has doubts that a person has enrolled in Obamacare (the legal name is Affordable Care Act) and are claiming poverty but are not poor, there are numerous ways to investigate and prove that. My bet is ANYONE who has enrolled in ACA IS A LIVE PERSON and not a ghost or phantom, till proven otherwise. PERIOD!
You are certainly right that healthy enough to not get sick does not mean they are a phantom or a ghost or a case of fraud.
Though, actually, the CMS and Paragon claims are not that simplistic as each case of no claims = definite fraud.
It's based on them finding no-claim rates too high (compared to what is usual for health insurance) in certain groups, so they're trying to conclude there is extensive fraud, without identifying particular individuals.
However, the flaw is that the particular group they are looking at to claim extensive fraud can be expected to have a low claim rate for easy to understand reasons. (They are picking up insurance only when it is free, and may be young and healthy, very low income and not particularly concerned about their health, not worried about medical costs occuring because they have no savings to lose, etc. It's not the same as the group of people who would normally have health insurance that they have to pay for.)
The government has to admit that this is a failed experiment and a complete waste of money. They are worried about Part A insolvency? We know where to start.
I don't believe MA is a failed experiment. It was a handout to donors that was supposed to eventually get rid of Medicare and replace it with a privatized system.
It may have failed to completely replace Medicare.
Corporate welfare is corporate welfare, although it can be dressed up in many different ways.
It's a cash cow that won't go to pasture quickly.
True.
A fraction compared to our health care system that has transferred $79 trillion and counting from workers to wealthy 1%.
Good point.
Sounds like "waste, fraud and abuse" to me.
Where are the front page headlines?
Why isn't the FBI and DOJ having the CEOs do "perp walks"?
Asking for a friend.
I suppose Elevance didn't bribe the current regime enough to get away with this scam.
That fraction (of wire transfer)
is probably less than zero % of corporate welfare/tax payer dollars given to the private for-profit commercial health insurance industry & in turn agents & lobbyists. Horrible
With such anger and distraught among the bilked, it is no surprise, no matter how horrible, that an assassin became a folk hero. We need a total overhaul of Congress and bribed regulators. We need a universal healthcare one-payer plan for all. 75% of the people polled agree. And let’s be honest, the military budget has become unsustainable and needs to be cut in order to meet the nation’s essential daily needs.
Sounds like official waste fraud and abuse. Serves them right. Now let’s find their federal enablers.
They should be kicked out of all Federal programs! They knowingly committed fraud against the government, and paid a small fraction of that back. Wish we could get away with that... I thought that's what the law says in FWA.
Medicare Advantage came about because W wanted to help his insurance buddies make money. It's a ripoff.
I indicated yesterday, reasonably-on-topic, about the recently-made CMS claim that the full large amounts reductions, several millions and increasing, of the number covered by ACA on-exchange coverage, is fully due to the administration's successful crackdown and fraud, and is not due at all to the lapsing of the ACA expanded subsidies that the Republicans made happen 1/1/26.
(comment: https://healthcareuncovered.substack.com/p/unitedhealth-has-a-bank-now-washington/comment/285596398
pointing to my assessment of the CMS claim:
https://normspier828307.substack.com/p/the-administrations-claim-in-the )
I will not repeat that, but I feel that, since that claim, sure to be widely tossed about in the months before the midterms, is dependent of the rather-propagandistic term "phantom", sort of based on people who have ACA coverage but never file a claim, I feel it is important to immediately inform HEALTH CARE un-covered readers, who I believe tend to be very versed in the details of health insurance, that there is alternative terminology in use.
It seems to be geographical.
So, I have observed "ghost", which seems to be used or emphasized in certain locations, rather than "phantom".
For example, here:
https://www.youtube.com/watch?v=ZBAsIq9UUsg&t=374s
is Republican Sen. Roger Marshall, of Kansas, using it. He says:
"Get this. 35 to 40% of Obamacare recipients that are enrolled in Obamacare never file a claim. Let me say that again. There’s 24 million people on Obamacare. 35-40% of those people never file a claim. These are ghost people. They don’t even know they’re on Obamacare."
I really don't know why the different term for the same thing. It causes confusion!
Sen. Marshall, certain coastal elites may have nastily asserted, changed “phantom” to “ghost” because he thinks most people in Kansas don’t know what the word “phantom” means.
(I have no opinion on the matter.)
I do just want to make sure Wendell Potter readers recognize both words, so they can be up on the policy debate.
(Perhaps, also, "Obamacare is haunted", if encountered, can be expected to really be the same claim.)
So let me get that straight - if I am enrolled in Obamacare and pay the premium but never file a claim (because I don't go to the doctor or don't get sick), I am a "ghost" or "phantom"?! Make that make sense.
Well, roughly, There's a little more to it than that. The Paragon Health Institute, and now CMS, is claiming that TOO MANY PEOPLE, particularly in the low-income under-150% FPL group, have been in the no-claim category, after people in that income zone, due to the expanded subsidies, have to pay no premium for the coverage.
The flaw is that, though looking consistent with a fraud explanation, that's also consistent with very-low income people, who are very healthy, getting the coverage only when it is free. Which could happen for multiple reasons in that group.
Possibly the fullest explanation of the multiple reasons (that I can think of) is within my second comment of the comment and reply to myself here, on Dean Baker today:
https://substack.com/@normspier828307/note/c-286084530
(For people with a little time on their hands, the right skills, and with sufficient interest, a fun activity could be to go through both the CMS report issued 6/26/26, and the Paragon Health Institute report issued earlier in June, and figure out what has gone on. That's what I did, and it was indeed fun!)
This response does not address my question. Whether one pays premium out of pocket or someone pays for him/her (in the form of subsidy) DOES NOT MEAN they are a phantom or a ghost. They are live people, luckily healthy enough to not file a claim but enrolling in insurance in order to be covered IN THE EVENT THEY GET SICK. That’s how generally insurance works. If someone has doubts that a person has enrolled in Obamacare (the legal name is Affordable Care Act) and are claiming poverty but are not poor, there are numerous ways to investigate and prove that. My bet is ANYONE who has enrolled in ACA IS A LIVE PERSON and not a ghost or phantom, till proven otherwise. PERIOD!
You are certainly right that healthy enough to not get sick does not mean they are a phantom or a ghost or a case of fraud.
Though, actually, the CMS and Paragon claims are not that simplistic as each case of no claims = definite fraud.
It's based on them finding no-claim rates too high (compared to what is usual for health insurance) in certain groups, so they're trying to conclude there is extensive fraud, without identifying particular individuals.
However, the flaw is that the particular group they are looking at to claim extensive fraud can be expected to have a low claim rate for easy to understand reasons. (They are picking up insurance only when it is free, and may be young and healthy, very low income and not particularly concerned about their health, not worried about medical costs occuring because they have no savings to lose, etc. It's not the same as the group of people who would normally have health insurance that they have to pay for.)