The bigger Obamacare problem

OPINION:

Congress is once again grappling with how to repair a broken health care system and its runaway spending.

Although the subsidies keeping Obamacare afloat expired at the end of last year, the fight over whether to continue borrowing and throwing good money after bad policy is far from over. The House of Representatives has unwisely decided to keep wasting more money to hide Obamacare’s failures, and the issue looms over yet another potential government shutdown.

Although the House opted to expand Obamacare yet again rather than acknowledging that the pandemic subsidy expansions were too costly and lacked basic safeguards, its leadership is searching for low-hanging fruit that can unify the Republican conference.

One component of Obamacare that quietly continues to waste taxpayer dollars and also warrants the spotlight for extermination: the Center for Medicare and Medicaid Innovation.

Created under Obamacare to test payment models and lower costs, the center was intended to run small, voluntary pilot programs. Fifteen years later, it has evolved into a back door for government-controlled health care. Instead of experimentation, the center increasingly imposes nationwide rules without congressional approval that resemble failed government-run policies rather than innovation.

Congress never intended for the Center for Medicare and Medicaid Innovation to replace lawmakers in setting national health care policy, yet that is effectively what has happened. The center now has the authority to reshape Medicare and Medicaid across all 50 states without a single vote in Congress, operating as an unaccountable regulatory agency inside the Department of Health and Human Services with minimal oversight.

Even worse, the Center for Medicare and Medicaid Innovation has failed on its most basic promise: saving money for patients and taxpayers. According to repeated analyses by the Congressional Budget Office, the program has increased federal spending rather than reduced it. Instead of generating $2.8 billion in projected savings from 2011 to 2020, the center lost taxpayers $5.4 billion.

A 2021 analysis found that out of 172 Medicare-related models, only four met the statutory criteria for expansion and just 15% reduced costs. Addressing this waste could save Americans nearly $10 billion per decade.

The consequences go beyond the federal budget. Several models disrupted patient care, reduced access to therapies and lowered patient satisfaction. Mandatory participation forces physicians and patients into one-size-fits-all payment experiments, echoing socialized systems where bureaucrats, not doctors, make key decisions about care.

That approach violates the Center for Medicare and Medicaid Innovation’s bipartisan intent. Congress authorized voluntary, limited pilots, not mandatory national models that treat patients as test subjects. The shift toward coercive models represents a clear mission, allowing each administration to impose partisan agendas or reverse its predecessor’s policies without returning to Congress for approval.

Although the current focus on Obamacare subsidies is beneficial and should continue beyond the COVID-19 subsidies, targeting waste and obvious failures, such as the Center for Medicare and Medicaid Innovation, would be a meaningful way to claw back taxpayer dollars while grappling with Obamacare’s broader challenges.

As long as the Center for Medicare and Medicaid Innovation exists in its current form, Washington bureaucrats will continue to make sweeping changes to Medicare and Medicaid without patients, providers or even Congress weighing in.

Every day, it becomes more and more clear to the American people that Obamacare is destabilizing costs and making quality care more unaffordable. The law is still worthy of full repeal. In the meantime, Congress could take a strong step in that direction by terminating this failed, costly experiment in top-down government.

• Paul Teller is president of Teller Strategies.