Medicaid: Last Week Tonight with John Oliver | Transcript

Main segment: Medicaid. Other segments: revival of the 1864 Arizona abortion law, 2024 South Korean legislative election
Medicaid: Last Week Tonight with John Oliver

Last Week Tonight with John Oliver
Season 11 Episode 8
Aired on April 14, 2024

Main segment: Medicaid
Other segments: revival of the 1864 Arizona abortion law, 2024 South Korean legislative election

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[Cheers and applause]

JOHN: 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 died– 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 versus 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 gap. Ahn Cheol-soo, people’s power, currently in first place with 62%.

JOHN: Wow, this may be the first time I’m going to 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 all out. They even had a candidate parachuting down towards the train and kicking in 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 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’d love to talk about south korean election 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 War is enforceable. Under the long-dormant 1864 law, abortion is a felony. Performing or assisting a woman with having one is punishable by imprisonment.

JOHN: Yeah, 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 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 war-era laws on reproductive freedom? I mean, women didn’t 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 war on any issue, for obvious reasons here, right?

Point taken.

JOHN: Yeah, I hope the point’s 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.” True, but also: maybe not the worst thing people didn’t have the right to do back then. It’s worth taking a moment on just how arcane this law really is. It was written as part of the first set of laws for the Arizona territory, which also legalized consensual sex with a 10-year-old, and spelled out the crime of “excusable homicide,” which include 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. Murder your child for pissing you off? That’s okay, as long as you’re moderate and don’t make it into a whole thing. Now, it’s unclear exactly when Arizona’s abortion ban will go into effect. What is clear 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. And 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, just as long as she hadn’t done an interview in which she supported that law, even specifically citing 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.

JOHN: Look, if you’re gonna backtrack on something, 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 something MSNBC would try to use as a sick burn for Trump’s motorcade or whatever, but it’s actually just some guy’s podcast. But it’s going to be hard for state Republicans to distance themselves from all 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. 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 he also once did this.

An Arizona Supreme Court justice accused of racism after an old video surfaces on social media. In the clip, 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.

JOHN: 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 not on display there. With his injured arm, he looks less like a reggae musician and more like he’s starring in a racist 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, you vote a certain way. I have no regrets. You vote a certain way based on the information that you have at the time.

JOHN: 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 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 fuck up your whole life, couldn’t it? If only there were some obvious parallel we could use to illustrate how frustrating that would be! This Arizona decision is so toxic, even Donald Trump this week knew enough to try and condemn it.

Did Arizona go too far?

Yeah, they did. And that’ll be straightened out. As you know it’s all about state’s rights. It’ll be straightened out. I’m sure that the governor and everybody else are going bring it back to reason and that’ll be taken care of very quickly.

JOHN: Okay, there’s a lot to hate there, from blaming Arizona for a mess he largely created to invoking “state’s rights,” a phrase famously associated with peaceful compromise. But despite Trump’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’s 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 likely to also 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 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.


JOHN: Moving on. Our main story tonight concerns healthcare. The industry that’s done basically no innovating in the past fifty years when it comes to big rolls of paper you plop your bare ass on. Specifically, we’re going to talk about Medicaid– the public insurance program that provides health coverage to people with low incomes. It is massive, representing $1 out of every $6 spent on health care 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. We took you off the books.

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.

JOHN: It’s true! People have been getting kicked off Medicaid, 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’d be something! He’d fit in so naturally, you may not even have noticed, he’s in there! There he is! And that’s better! Mt. Rushmore’s better with Shrek on it! And the thing is, all 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 put out PSA’s like this one, to alert people to the changes that were coming.

Hey! Did you know that 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 staycovered. – and update your contact information.


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.

JOHN: It’s excellent. It’s all 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 U.N. 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 suddenly go, “owww! Stop it, you’re hurting me!”
Unfortunately, despite magnificent PSA’s like that, not everyone heard about the Medicaid unwinding, or knew exactly what they had to do to keep their healthcare. And what that’s 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 they had to do anything to maintain their Medicaid coverage– then suddenly found 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 7-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.

JOHN: That is terrible. Because anyone could tell you that kid needs medical treatment. I could tell you. A magic 8-ball could tell you. 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’d ignore them both and write in the sand, “what the fuck 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’s a purely federal program, open primarily to Americans 65 and older, Medicaid is a partnership between the federal government and states, where the federal government contributes at least $1 in matching funds for every $1 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.

JOHN: Exactly, when Medicaid works, it can be amazing. Unfortunately, it often doesn’t work that way, which you can probably guess by the fact 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. Can you imagine? You’d be watching an impossibly horny 30-minute deep dive on Negronis. That’s a better show. I wish this were that show. You wish this were that show. But 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 that in general, even for those who qualify for Medicaid, it can be incredibly difficult to access. And the problems begin with basic administrative fuckups– like what happened to this 1-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– 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.

JOHN: Wow. 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’s 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 born. I’ve made this into a decision tree, but it doesn’t feel like it should have been 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 a real effect. Even before the chaos of the unwinding, in 2022, about a quarter– 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 careless about doing that, as one family lost coverage after their renewal packet was accidentally mailed to a horse pasture. Because horses aren’t eligible for Medicaid. They get healthcare through a different program, called the glue factory.
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 shit 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 it’s okay to make fun of for something that’s not their fault, and that’s secret service agents, for the fact they’re 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 it.
But there are times when it feels like the obstacles to getting Medicaid have been put there deliberately, so states can keep those 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 Trump 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– the human person. So often I say that our– our– sometimes our charity becomes toxic to people. In our wanting to help them, sometimes we’ve– we’ve hurt them.

JOHN: Okay, putting aside that calling access to basic healthcare “charity” is immediately infuriating. “It’s something that’s about the human person?” Are you sure that’s a sentence? It sounds more like something a drunk alien would say while trying to describe a David Foster Wallace book. “It’s something that is 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 six months in, 18,000 Arkansans had been stripped 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.

JOHN: Yeah, 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 has one right and it’s proving just as stupid and just as upsetting. And that’s 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 the time.

The people in my district that work hard, that struggle to pay their health care, 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?

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.

JOHN: Look, it goes without saying that I disagree with Matt Gaetz on a lot of issues: his stance on immigration, his stance on gun 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 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. So her only real “crime” there was not wanting to stand in line at the DMV for eight 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 the total would amount to less than $900,000″ compared to the office’s budget of $6.4 million a year. And look, I’m not an accountant despite having resting “budget analyst” face. But even I know that makes no financial sense. And look, 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 shit like this.

A husband and wife living a fairy tale lifestyle paid for by all of us. Over a 3 to 4 year, they were true jet setters in their private $900,000 plane. The Harron’s 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.

JOHN: That’s 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. Like, when you said the phrase “$17 million dollars,” you didn’t feel the need to show this stock footage of cash slowly falling out of the air. 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 your 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-back ground version, but once I saw the “red”-text-over-“neon”-green one, I was like…wow, that’s so true. That’s totally what he’s doing.
But that’s 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 4-year-old. Which is a little difficult to believe. If toddler alcoholism were an actual problem in this country, you’d have definitely seen a TLC series about 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 health care 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’s one last, massive flaw with our Medicaid system. And it has to do with Managed Care Organizations, or MOC’s. These are private companies states contract to deliver and pay for healthcare. Currently, 72% of Medicaid beneficiaries are enrolled in a plan care overseen by an MCO. And it’s big business. The five biggest MCO’s 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, it’s been out of favor, but Michael Neidorf tells such a compelling story.

Michael Neidorf, 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 health care.

You have Michael Neidorf on all the time.

No, Centene. I think that Michael Neidorff is amazing.

By the way, he looks great for 77.

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

JOHN: Okay, you already knew that 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– died just four months later. It seems any optimistic prediction that Jim Cramer’s involved with is enough to kill 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.
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 went on to settle similar allegations in at least 19 states, for nearly $1 billion. And I would argue 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 MCO’s is that– as with so many players in our for-profit healthcare system– they’re incentivized to cut costs at the expense of necessary care. Because MCO’s 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 MCO’s denying care and prioritizing cost savings over patients. There’ve been headlines about it in Florida, headlines in Texas, and headlines in Iowa. And just to focus on Iowa, it transitioned to using MCO’s 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– 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– his state of mind, not understanding why all this was happening.

JOHN: 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.

JOHN: Look, I’ll be honest, when I first heard that, I thought, “that has to be taken out of context. There’s no way a doctor– a licensed physician– would testify, in a hearing, that he thinks it’s okay if people sit in their own shit 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.

JOHN: Yeah, I’m struggling for words, too. I will say, Louis kind of nailed it by blowing that raspberry– and I did appreciate that reporter doing a full “Jim from the office” look to camera and nodding. But if I absolutely had to put it to words, I’d say “fuck 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 fucking orders.
And while legally, I have to tell you, AmeriHealth wants me to tell you Louis did get that service restored, I’ll point out: it was only “after” his story made the news. 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 47-page forms to horses, states could instead rely on information they already have in their databases. That seems like it would make bit more sense. Michigan’s 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 MCO’s, 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 that, the very least we can do is make Medicaid PSA’s that actually 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 I’m, but that’s not important right now.

What you mean, and all peaches always talk?

Sure we could, but don’t focus on that because I want to talk to you about Medicaid.

Is anybody else seeing this talking peach?

The problem is different to pending on where you live.

The good news is in all states generally low-income children, pregnant women, and family are eligible for Medicaid p.r.

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

You have no idea. He’s right, take my state taxes. Oh, my god, there is you. What is nothing? I’m a sweet potato. Let’s say you’re a single mom with two kids. If you are making over $344 a month, you’re not eligible for Medicaid at all. It’s true and then Georgia if you don’t have kids, you better be working. Otherwise you can’t get Medicaid. Hey, good for you, you’re not running a charity over there. There is dignity work. It’s something about the human person. Hey, y’all, I’m from Louisiana. What’s up with this one’s eyes? Yeah, this one has wrong eyes eyes. We check your finances every three months to make sure you haven’t gotten some overtime or picked up work. Gets one, and in Wyoming, you can qualify for Medicaid at all! No matter what your income is! There is literally no way to qualify for it! Oh, my lord, is not true? Out of work and making money? Yes? That’s messed up. I agree with the coconut, that is super fucked up. Come over here, buddy, stand over on this side away from the produce. Don’t worry, his Medicaid coverage won’t be cut. Unless you don’t fill out the proper paperwork but maybe if you do. There’s a glitch in the system like I don’t know, mailing your form to a horse pasture. It’s happened, y’all! How did your kid was really born anyway? Excuse me? If the kid was not born he doesn’t get Medicaid. Prove he was born! [Chanting “prove he was born”] prove he was born! I don’t have to prove anything to you! Your vegetables! The child is the proof! Listen, I know it’s all complicated so feel free to give your state Medicaid office a call if you have any questions. Be patient though, and for the it takes more than an hour to get a live person on the phone. No way, dude! [Speaking non-English language] I don’t speak Spanish. He said there’s an 80% chance your call will be disconnected by accident. Once even the point of calling then? Because it’s a fun thing to do. I agree. Okay, we’re leaving now, thank you Mr. Peach. Mr. Beachy is my brother. And you and him last week. And now we are going to eat you! Oh, shit. [Screaming]

JOHN: That is our show, thank you so much for watching! We’ll see you next week. Good night!

Exceeds me, hello, can you help me? Can you remove this husk from my eye? Is hanging down. It’s hanging over. Please. I’d like to see in both eyes. Por favor. I don’t have hands. Gracias. Thank you for doing that.


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