Already under fire from Democratic senators that think he is unqualified to be Health and Human Services Secretary, Robert F. Kennedy Jr. misstated several times how Medicare and Medicaid — two massive public health programs that cover senior citizens and low-income Americans, respectively — operate during his Senate Finance Committee confirmation hearing on Wednesday.
If confirmed as to lead the department, Kennedy would oversee these programs, which cover more than 150 million Americans.
Kennedy stumbled during an extended exchange with Republican Sen. Bill Cassidy of Louisiana, who is a doctor, over potential reforms to Medicare and Medicaid. Cassidy leads the Senate Committee on Health, Education, Labor and Pensions, which holds its confirmation hearing on Kennedy on Thursday. The senator will be a pivotal vote on Kennedy’s nomination.
At one point, Kennedy said that Medicare is “fee for service,” meaning that the federal government pays providers to care for enrollees, and that the program is paid for by employer taxes. However, just more than half of Medicare enrollees — including Kennedy himself, he noted later in the hearing — are in Medicare Advantage plans run by private insurers who are paid by the government to care for beneficiaries. Also, Medicare has multiple funding streams, including enrollee premiums and government support.
On the other hand, Kennedy said that Medicaid is fully funded by the federal government and is not fee for service. In fact, Medicaid is jointly funded by the federal government and states. Also, while most Medicaid enrollees are in managed care plans run by private insurers, some remain in fee for service payment models.
Also, Kennedy said that premiums and deductibles in Medicaid are too high. However, only one state, Iowa, is believed to charge premiums to certain enrollees, according to KFF, a nonprofit health policy research organization. Georgia has received a federal waiver to levy premiums, though KFF does not believe the state is currently doing so.
Many states do charge nominal copays for certain services, such as prescription drugs and in-patient hospital care, according to KFF.
The federal government limits the premiums and cost sharing, including deductibles and copays, that states can impose on enrollees.