“Pilfering The Federal Treasury”: Mitt Romney’s Medicaid Shell Game
Mitt Romney is lambasting federal aid in his campaign for the presidency, including derisive comments against those who receive government assistance. But he pulled all the stops to pursue federal aid as governor of Massachusetts, even hiring “revenue maximization” contractors to scour federal programs for every possible penny — and using financial schemes to maximize and then divert the aid from his needy constituents.
In his first budget proposal, Romney promised balancing the budget without tapping reserves, and “without the use of fiscal gimmicks.” However, buried in the details, he suggested tapping reserves such as taking $4 million from the Catastrophic Illness in Children Relief Fund, and he included fiscal gimmicks to maximize and divert federal aid into his general state coffers.
His strategies are akin to tax schemes using offshore bank accounts — but instead of avoiding federal taxes, seeking to pilfer the federal treasury. The Wall Street Journal labeled such financing mechanisms “Medicaid Money Laundering” and a “swindle.”
Medicaid is a matching grant program. If a state with a 50 percent match rate like Massachusetts spends $50 on qualifying services, the federal government will provide an additional $50 so there is $100 total for Medicaid services. The federal match payment is much higher in some states, such as Mississippi where its almost 75 percent.
Unfortunately, some states concocted budget shell games, often with private consultants, providing an illusion of state spending to claim federal matching funds, when no state spending has occurred. As governor of New Hampshire, Judd Gregg developed such a practice labeled “Mediscam.” Gregg taxed hospitals serving the poor, routed the money into an “uncompensated care fund” which he sent right back to the hospitals, and used the round-trip of money to claim federal matching funds. Then, the swindle gets worse, because he routed the federal Medicaid funds into his general coffers rather than for Medicaid services.
Romney’s schemes were similar to Gregg’s. Buried in his 2004 budget, Romney proposed maximizing federal aid by taxing hospitals, shifting the resulting tax payments in and out of an uncompensated care fund, back to hospitals as adjustment payments, and diverting resulting federal Medicaid funds to state general revenue. He also proposed using taxes on nursing homes and pharmacies in his efforts to maximize and divert federal aid.
In such strategies, health care facilities serving the poor are used to claim federal funds to help the poor. But the health care facilities and the poor may get nothing, as the state diverts the federal aid to general coffers — and revenue maximization contractors reap millions in contingency fees. Romney used such private companies to help carryout his strategies.
After a US General Accounting Office report responding to concerns of Republican Senator Charles Grassley, the Romney administration vigorously defended using contingency-fee revenue maximization consultants and revenue practices – that the GAO labeled illusory. The GAO responded that “hospitals should benefit from increased federal reimbursements and Massachusetts’s arrangement appeared to result in lower payments to hospitals, despite increased claims for federal reimbursement.” The Romney administration even defended double (if not quadruple) billing practices “of allowing multiple agencies to bill Medicaid” for “services for the same beneficiary.” The GAO concluded that the Romney administration “did not provide convincing evidence that the [Medicaid] services provided by the four state agencies were unique,” and the Bush administration agreed with the GAO’s conclusions.
The Bush administration implemented regulations trying to reduce such practices, and the Obama administration continues efforts to improve fiscal integrity in the Medicaid program. However, Romney would virtually end federal oversight by block-granting federal Medicaid funds to states.
It’s not hard to imagine how a governor — one that employs complex shell games to find loopholes in federal rules in order to maximize and divert federal aid — would use the federal funds if handed to the state without any federal oversight. The answer to state misuse of federal aid is not to give those states even more discretion to do whatever they wish – but to simplify the claiming process, reduce loopholes allowing the revenue schemes, and improve oversight to ensure Medicaid funds are used as intended.
Romney has undergone dramatic and hard to follow shifts in his apparent views of government aid. Romney2004 proposed cutting healthcare while simultaneously proposing illusory schemes to maximize and divert federal Medicaid funds. Romney2006 changed course with the first nearly universal healthcare plan. Now Romney2012 is turning back to cuts, denouncing federal aid he once schemed to maximize and divert, condemning those who need government aid, and seeking repeal of national health care reform that is nearly identical to the plan he signed into law. And now he proposes giving all the federal money from the Medicaid program to states without federal control.
Romney2004 would have a field day with Romney2012’s plan.
By: Daniel L. Hatcher, Law Professor, University of Baltimore, Published in The Boston Globe, October 12, 2012
“Moderate Mitt” Isn’t Back”: He Suddenly Talks Like One But Is Only Embracing The Rhetorical Strategy Of George W. Bush
The news overnight was that Mitt Romney had decided to do a mea culpa for the secretly recorded “47 percent” remarks that rocked his campaign a few weeks ago, calling them “just completely wrong” in an interview with Sean Hannity.
This came 24 hours after a debate in which Romney labored to present himself as more of a pragmatist than an ideologue, objecting insistently when President Obama tried to link him to conservative economic ideas that would threaten the safety net. And it came a little over a week after Romney invoked his own Massachusetts healthcare law – a law that served as the blueprint for Obamacare and that Romney ignored as much as possible during the Republican primaries — as proof of his commitment to aiding poor and middle-class Americans.
These developments are leading the press to declare that Romney is moving to the center – and some pundits to celebrate the supposed return of Mitt the Massachusetts Moderate. But this is a complete misreading of what Romney’s actually up to.
Yes, it’s true, he’s been striking a more moderate tone of late. And for good reason. In the Obama era, the Republican Party has moved far to the right, reflexively opposing every major Obama initiative (even those grounded in traditionally Republican principles) and imposing stringent purity tests on its own candidates. The result is that the GOP never bothered these past four years to formulate a coherent and marketable policy blueprint. To the masses, the GOP’s main selling point has been – and continues to be – this simple message: We’re not Obama. To the extent the party has spelled out affirmative policy ideas, it’s mainly created headaches for Republican candidates running in competitive general election contests.
Romney has long been aware that he can’t actually run on the ideas that his party has generated these past few years, but he’s been further constrained by the right’s deep suspicion of his own ideological credentials. Thus, Romney has spent most of the general election campaign awkwardly switching between vague, broad-stroke pronouncements aimed at swing voters and gestures that mesh with the radicalized, Obama-phobic spirit of today’s GOP base.
What’s changed in the last week or so is the balance: Romney is now primarily pitching his message at non-GOP base voters – people who are likely to recoil at the implications of the policy ideas that the national Republican Party has embraced – and skipping the red meat.
His debate exchange with Obama over taxes is a perfect example. Romney is clearly vulnerable on the issue; the plan he’s presented would slash tax rates in a way that disproportionately benefits the wealthy, and would either explode the deficit or require the elimination of popular, widely used tax deductions. This reflects the actual priorities of the Republican Party, but it’s also at odds with what most Americans (who consistently tell pollsters they don’t like deficits and want taxes on the wealthy raised, and who are fond of their tax deductions) want. Romney’s solution: Insist during the debate that the rich won’t get a tax break and that the deficit won’t explode and avoid specifying any deductions that might be on the chopping block. Given his strong delivery (and Obama’s inability to force him off his script), Romney probably succeeded in sounding reasonable and moderate to most casual viewers.
He played the same game on other sensitive subjects that came up during the debate, like healthcare and education, and his decision to repudiate his own “47 percent” remarks – something he refused to do when the tape was first released a few weeks ago – marks another step toward the rhetorical middle.
Comparisons between Romney now and George W. Bush in 2000 are becoming popular, since Bush employed the same basic strategy in his campaign that Romney used in the debate. There’s an important difference, though: Bush’s platform actually included some nods to moderation. With Romney, it’s only his words.
For instance, Bush called for an expanded federal role in education, which translated into No Child Left Behind, and for federal action to make prescription drugs more affordable for seniors, which led to the creation of Medicare Part D during his presidency. You can certainly take issue with how these laws were crafted and implemented, but Bush’s willingness to pursue them at all represented a break from conservative dogma.
But Romney’s actual platform contains no moderate planks. For instance, he tried to assuage middle-of-the-road voters on healthcare by insisting during the debate that he would repeal Obamacare without sacrificing its popular features, like a ban on the denial of coverage based on preexisting conditions. “No. 1,” Romney said, “preexisting conditions are covered under my plan.” It’s essential for any candidate trying to appeal to general election swing voters to say this, but the actual policy Romney has proposed would not have the effect he described.
Education is another example, with Romney asserting that, “I love great schools. And the key to great schools, great teachers. So I reject the idea that I don’t believe in great teachers or more teachers.” Again, this is tonally in line with what middle-of-the-road voters want to hear, but where is the policy to back it up? As president, Obama presided over a stimulus program that saved hundreds of thousands of teachers’ jobs, and he proposed further action through the American Jobs Act last fall. Romney has railed against both of those programs and not offered any blueprint for hiring more teachers.
This is probably why conservative opinion-leaders seem so unbothered by Romney’s shift to the middle. They recognize that it makes him sound more agreeable to swing voters and that it could help in how he’s portrayed through the media. And they also realize that no matter how much he talks like one, there’s absolutely no reason to believe that a President Romney would govern like a moderate.
By: Steve Kornacki, Salon, October 5, 2012
“Mitt Romney’s Terrible Laugh”: He Knows What He’s Saying Is Utter Baloney And He Knows That We Know
Some public figures get defined by a single image, or a single statement (“Ask not what your country can do for you”; “I am not a crook”). Others have a characteristic linguistic tic or hand gesture that through repetition come to embody them; think of Ronald Reagan’s head shake, George W. Bush’s shoulder-shimmy, or that closed-fist-with-thumb-on-top thing Bill Clinton used to do.
For Mitt Romney, it’s the laugh. I’m sure that at times Romney laughs with genuine mirth, but you know the laugh I’m talking about. It’s the one he delivers when he gets asked a question he doesn’t want to answer, or is confronted with a demand to explain a flip-flop or a lie. It’s the phoniest laugh in the world, the one New York Times reporter Ashley Parker wrote “sounds like someone stating the sounds of laughter, a staccato ‘Ha. Ha. Ha.'” Everything Mitt Romney is as a candidate is distilled within that laugh—his insincerity, his ambition, his awkwardness, and above all his fear. When Mitt laughs that way, he is not amused. He is terrified. Because he knows that what he’s saying is utter baloney, and he knows that we know it.
So he pretends to find it hilarious that an interviewer wants him to explain why, say, Romneycare was great for Massachusetts but the nearly identical Obamacare is a Stalinist horror for America. Perhaps it is the pain of enacting this facsimile of delight so many times that has hardened Mitt’s heart and allowed him to run what has become a campaign of truly singular dishonesty. But whatever moral calculation underlies the decisions he makes, this is the place we have arrived: There may have never been a more dishonest presidential candidate than Mitt Romney.
I say “may,” because measuring dishonesty with any precision is an extraordinarily difficult challenge, perhaps an impossible one. But by almost any standard of mendacity we could devise—the sheer quantity of lies, the shamelessness with which they are offered, the centrality of those lies to the candidate’s case to the voters—Romney has made enormous strides to outdo his predecessors.
It started before he even began his campaign, when Romney wrote an entire book premised on a lie about Barack Obama. Romney’s pre-campaign book, called No Apology: The Case for American Greatness, was built on the idea that Barack Obama makes a habit of apologizing for America, and Mitt Romney would do no such thing. “Never before in American history,” Romney wrote, “has its president gone before so many foreign audiences to apologize for so many American misdeeds, both real and imagined.” The actual number of times Barack Obama has gone before a foreign audience to apologize for American misdeeds is zero, as has been extensively documented. Undaunted, Romney began his campaign by repeating the lie of the Obama “apology tour” hundreds of times, before audiences all across the land.
And that was just the beginning. If you have the better portion of a day, you could wade through the lengthy catalogue of deceptions blogger Steve Benen has assembled under the heading “Chronicling Mitt’s Mendacity.” Periodically, Benen puts together 20 or so Romney falsehoods for a post; his latest installment is the 29th in the series.
They come in all shapes and sizes. Some of things Romney says are clearly, factually false and seem to come out of no place other than the “this is the kind of thing a socialist like Obama would do” corner of Romney’s imagination, as when he claimed that Obama raised corporate tax rates (nope), or alleged that “President Obama is shrinking our military and hollowing out our national defense” (the military budget has increased every year Obama has been in office). Others are bizarrely false, as when he has said multiple times that the Obama administration hasn’t signed any new trade agreements (since Obama took office we have new trade agreements with South Korea, Panama, and Columbia). Others sound like they just popped into his head and felt true, even though they’re utterly wrong (“We are the only people on the earth that put our hand over our heart during the playing of the national anthem”). Some things he says are technically matters of interpretation, but are so absurd that no honest person could say them, as when he claims that under Obama, “we’re only inches away from no longer being a free economy.” Others are seductively specific, yet completely made up (“Obamacare also means that for up to 20 million Americans, they will lose the insurance they currently have, the insurance that they like and they want to keep”).
But what is truly notable is how often Romney has put a lie at the center of his campaign. It’s one thing to say something false in passing, perhaps when speaking extemporaneously. It’s something else to tell a lie, then repeat it again and again on the stump, then put it in a television ad broadcast across the country, then send your surrogates out to repeat it to every camera they can find.
As you’ve no doubt seen, few of Romney’s lies concern himself. He may gild a lily here and there about his record and his past, but the overwhelming portion of his deceptions are about Barack Obama—what he has said, what he has done, and what he believes (whenever you hear Romney say, “Barack Obama believes …” you can be certain he is about to say something ridiculously untrue). The new Romney attack on welfare—falsely claiming that the Obama is eliminating work requirements in the program—is only the latest, but it’s hardly the first. Before that it was “you didn’t build that,” which set a new standard in deceptive use of an out-of-context quote. Before that were a hundred smaller lies about taxes, health care, the economy, foreign policy, and nearly every other subject that could possibly come up. One wonders if at some level Romney thinks he hasn’t compromised his integrity if he only makes things up about his opponent.
This is Mitt Romney’s own sin, of course, but it’s also a failure of journalism. If reporters were really doing their jobs, they would be able to provide enough of a disincentive for lying that no candidate would feel free to mislead so brazenly and so often. They wouldn’t mince words or fall back on false balance, but would forthrightly say that Romney is lying when the facts make clear he is. And so they might provide some punishment that would actually make Romney think twice before the next time he approves an ad script that says things that aren’t true.
I doubt it’ll happen. But if reporters decide that they really need to be more direct about Romney’s mendacity, they may start confronting him about it, in some of the rare non-Fox interviews to which he consents. Should that time come, Romney will no doubt laugh. “Ha,” he’ll say. “Ha. Ha. Ha.”
By: Paul Waldman, Contributing Editor, The American Prospect, August 14, 2012
“The Courage Of Convictions”: Dear Mr. Romney, I Want More Free Stuff From The Government
Dear Mr. Romney, I was hoping you could tell me how to get more free stuff from the government, and I see that you took up that question after your speech to the NAACP last week. You were speaking to a group of white people in Hamilton, Montana, and you told them that, at the NAACP, you had said that you were “going to get rid of Obamacare.” You said that they “weren’t happy” about that. And you said that if people want “more free stuff” from “the government,” they should “go vote for the other guy.”
Well, I want more free stuff from the government, but, actually, if you want free stuff from Obama, you’d be better off as a banker than as a black person.
Maybe you heard that Obama’s TARP and stimulus programs already gave $4.5 trillion in bailout money to the big banks and investment houses on Wall Street. There’s a lot more if you count loan guarantees and emergency lending from the Federal Reserve.
If I had gotten any of that free stuff, like your friends on Wall Street did, I could have done what they did—use those public funds to pay myself really well.
Some of your friends are praising you for your “straight talk” to the NAACP, for having the courage of your convictions and letting the chips fall where they may. But actually you didn’t tell the black people they should vote for the other guy because they want free stuff. Instead, you told a white audience afterwards that’s what black people should do.
Some people, like Matt Taibbi at RollingStone.com, thought your post-NAACP remarks were “shockingly offensive” and “cynically furthering dangerous and irresponsible stereotypes in order to advance some harebrained electoral ploy involving white conservative voters.” I can see his point.
But at the Center for the Study of Mitt Romney, they found that this isn’t the first time you said that people who want “free stuff” from the government should “vote for the other guy.” (Actually it was Rachel Maddow who found this.)
A few months ago, Rachel reported, you responded to questions about contraception access by saying, “If you’re looking for free stuff you don’t have to pay for, vote for the other guy.” You also complained that Obama was trying to buy students’ political support by offering them “free stuff.”
Rachel thought she could see a pattern here: “If you’re a woman who wants access to preventive care you might not otherwise be able to afford, Romney sees you as wanting ‘free stuff.’ If you’re a young student who can’t afford higher-ed tuition, Romney assumes you expect ‘free stuff.’ And if you’re a black person who wants your family to have access to affordable healthcare, Romney thinks you too are just looking for “free stuff.”
Of course, there’s another way to look at all this. You could say we are taking on the responsibility to see that everyone gets decent medical care, whether or not they can afford it. We want our friends and family and neighbors and co-workers who are uninsured or underinsured to be able to go to the doctor when they’re sick. We want the same thing even for people we don’t know. That’s the way minister Leslie Watson Malachi of People for the American Way explained it.
One other thing—it’s not just black people who will benefit from Obamacare. Most of the beneficiaries will be white—just in case the white people in Hamiltion, Montana got the wrong impression from your speech.
By: Joe Wiener, The Nation, July 14, 2012
“Keeping The Faith”: Why The Supreme Court Will Uphold The Constitutionality Of Obamacare
Predictions are always hazardous when it comes to the economy, the weather, and the Supreme Court. I won’t get near the first two right now, but I’ll hazard a guess on what the Court is likely to decide tomorrow: It will uphold the constitutionality of the Affordable Care Act (Obamacare) by a vote of 6 to 3.
Three reasons for my confidence:
First, Chief Justice John Roberts is — or should be — concerned about the steadily-declining standing of the Court in the public’s mind, along with the growing perception that the justices decide according to partisan politics rather than according to legal principle. The 5-4 decision in Citizen’s United, for example, looked to all the world like a political rather than a legal outcome, with all five Republican appointees finding that restrictions on independent corporate expenditures violate the First Amendment, and all four Democratic appointees finding that such restrictions are reasonably necessary to avoid corruption or the appearance of corruption. Or consider the Court’s notorious decision in Bush v. Gore.
The Supreme Court can’t afford to lose public trust. It has no ability to impose its will on the other two branches of government: As Alexander Hamilton once noted, the Court has neither the purse (it can’t threaten to withhold funding from the other branches) or the sword (it can’t threaten police or military action). It has only the public’s trust in the Court’s own integrity and the logic of its decisions — both of which the public is now doubting, according to polls. As Chief Justice, Roberts has a particular responsibility to regain the public’s trust. Another 5-4 decision overturning a piece of legislation as important as Obamacare would further erode that trust.
It doesn’t matter that a significant portion of the public may not like Obamacare. The issue here is the role and institutional integrity of the Supreme Court, not the popularity of a particular piece of legislation. Indeed, what better way to show the Court’s impartiality than to affirm the constitutionality of legislation that may be unpopular but is within the authority of the other two branches to enact?
Second, Roberts can draw on a decision by a Republican-appointed and highly-respected conservative jurist, Judge Laurence Silberman, who found Obamacare to be constitutional when the issue came to the U.S. Court of Appeals for the D.C. Circuit. The judge’s logic was lucid and impeccable — so much so that Roberts will try to lure Justice Anthony Kennedy with it, to join Roberts and the four liberal justices, so that rather than another 5-4 split (this time on the side of the Democrats), the vote will be 6 to 3.
Third and finally, Roberts (and Kennedy) can find adequate Supreme Court precedent for the view that the Commerce Clause of the Constitution gives Congress and the President the power to regulate health care — given that heath-care coverage (or lack of coverage) in one state so obviously affects other states; that the market for health insurance is already national in many respects; and that other national laws governing insurance (Social Security and Medicare, for example) require virtually everyone to pay (in these cases, through mandatory contributions to the Social Security and Medicare trust funds).
Okay, so I’ve stuck my neck out. We’ll find out tomorrow how far.
By: Robert Reich, Robert Reich Blog, June 27, 2012
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