Fannie Med

Perhaps you thought that the Affordable Care Act is all about making insurance more affordable. Too bad no one told Americans that the law also turned the Health and Human Services Department into a giant venture capital investor for health care. This won’t turn out well.

Awash in ObamaCare dollars, HHS has a growing investment portfolio that includes everything from new insurance companies to health-care start-ups to information technology. Secretary Kathleen Sebelius is rushing out loans and subsidies like nobody’s business in case the Supreme Court overturns the law or Mitt Romney wins. 

“We’re moving forward with implementing this law, including moving forward with this very important commitment by the President, by the Administration, to community health centers and the people they serve,” said senior White House aide Cecelia Munoz on a recent conference call with reporters. She was referring to $728 million in seed money for new clinics that HHS dispensed last month.

HHS already makes more grants than all other agencies combined, and it is the purchaser of health care for about one of three Americans via Medicare, Medicaid or both. The problem is that HHS spends its money—$788 billion for entitlements in 2012 and another $78 billion to run HHS’s 300-odd programs—so badly.

Ernst & Young’s annual outside audit of the HHS balance sheet last November was considered a triumph because several material weaknesses were downgraded merely to significant deficiencies. But on a “day-to-day or even monthly basis” HHS cannot accurately track its spending, according to the audit. The agency is in violation of numerous federal accounting rules written specifically for the bureaucracy, to say nothing of the financial reporting required of public companies.

The HHS inspector general revealed this year that his team can barely monitor HHS because its staff is too busy chasing the criminals exploiting HHS’s incompetence. Experts disagree about how much is stolen from taxpayers through entitlement fraud—the Government Accountability Office puts it at $48 billion annually—but one sign of the problem is that Medicare allows doctors (or “doctors”) to register for billing privileges as “other.”

One particular ObamaCare boondoggle that needs fly-specking is the HHS decision to finance nonprofit insurance companies with up to $7.25 billion in ultra-low-cost loans. These co-ops were a consolation prize for liberals after Democratic opposition killed the government-run public option, and the co-ops are supposed to be managed by and for consumers. But it turns out that running an insurance company is hard for amateurs who can’t attract private financing.

HHS officially estimates that the default rate on the loans will hit between 35% and 40%, which would be bad enough. But White House budget documents show that HHS expects to lose $3.1 billion of the $3.4 billion appropriated so far—which implies a default rate of 91%. The lack of accountability to shareholders or capital markets may help explain this propensity for failure.

Another problem is the way HHS chose to structure the co-op loans. To protect the insured, states require insurers to maintain reserves in the event they go bankrupt—and debts that are supposed to be repaid are viewed as liabilities. To end run these solvency requirements, HHS is issuing “surplus notes” that subordinate the taxpayer to everyone else for repayment if a co-op fails.

That seems likely, given the challenges of building a provider network and attracting members when expertise in such matters is legally prohibited under HHS rules. Any organization that wrote insurance policies prior to 2009—as it were, the pre-existing insurers of the Bush era—is barred from applying for loans or any significant role in the operations of a co-op. So the co-ops can’t benefit from the business experience that might give them a chance to succeed.

Then there’s Medicare’s so-called “innovation center” and its $10 billion kitty to make grants to companies and providers to test new methods for improving care. Democrats included language that bars administrative or even judicial review of the center’s financial decisions. Without any checks, this model replicates the rushed and haphazard loan process that led to the Energy Department’s Solyndra fiasco. (For an insider’s account of how HHS vets some of these grants, see Steven Greer’s op-ed nearby.)

President Obama says he wants the election to be about the failed investments of private-equity firms, but Bain Capital has nothing on the politicized investments of the Obama Administration. At least Bain is investing private money. HHS is squandering yours.