The Trump administration has rolled out a great new idea to allow states to impose work requirements on able-bodied Medicaid recipients. For 50 years, Medicaid has been treated primarily as a healthcare program that helps low-income people, but now the administration is officially enshrining the Republican view that it’s just one more form of welfare for greedy takers who just need a good shaming to make them stop being poor.
The Centers for Medicare and Medicaid Services (CMS) sent a 10-page letter to state Medicaid directors giving them authorization to make receiving Medicaid benefits conditional on having a job, being in school or a job-training program, proving they’re a caregiver for someone, or taking part in some other “community engagement” approved by the state. Now, before you get all “ARE THEY GONNA MAKE NURSING HOME RESIDENTS WORK IN COAL MINES,” the letter is quite clear that states can only throw people off healthcare for not working if they’re “non-elderly, non-pregnant adult Medicaid beneficiaries who are eligible for Medicaid on a basis other than disability.” So relax! Sending Meemaw to the coal mines is Phase III, and won’t even be considered until CHIP reauthorization is made conditional on the repeal of child labor laws.
As many as 10 states are already waiting for federal approval to impose work requirements on Medicaid recipients, and another three are mulling it over. The first waiver, probably for Kentucky, could get the go-ahead by Friday, according to sources who spoke to the Washington Post.
For what little it’s worth, the Post notes,
[Most] health policy experts, including a few noted conservatives, have regarded the government insurance enabling millions of people to afford medical care as a right that should not hinge on individuals’ compliance with other rules.
So much for that shit. While this isn’t a national work requirement, it’s definitely an invitation to red states to start tossing up creative roadblocks to low-income adults who need medical care. Because, you know, work is a very good thing, and it probably just hadn’t occurred to most poor people that maybe they should get a job instead of sitting around all the time. When CMS director Seema Verba was sworn in back in March of last year, she sent a letter to governors soliciting “innovations that build on the human dignity that comes with training, employment and independence.” Lord knows these bastards are fairly bursting with ideas to make people in poverty more dignified, the slobs.
The CMS letter perversely harnesses data showing that people with productive employment are healthier and live longer into the service of a plan to take away people’s healthcare if they fail to get steady work:
Maybe Michael Wolff has it wrong in that book Donald Trump Is A Tire Fire — looks like confusing causes and effects isn’t a problem that’s limited to Donald Trump. You know what all those studies really indicate? They show that not being poor is good for your health, not that people who are forced to jump through more and more hoops to get healthcare are healthier. Still, maybe we could borrow a line from their rationale there: Since it’s widely recognized that education can lead to improved health, how about we make community college tuition waivers available to anyone who qualifies for Medicaid? It’s a thought.
Fortunately, critics of the plan are already planning lawsuits. Leonard Cuello, the health policy director at the National Health Law Program, told WaPo, “It’s not a good idea, and it’s illegal.”
Cuello said the argument that work promotes health is “totally contorted . . . It’s a little like saying that rain causes clouds. It’s more that people [with Medicaid] get care, which helps them be healthy and makes them able to work.”
What kind of bizarro liberal logic is that? Next you’ll be saying that tax cuts for the rich won’t increase middle-class employment!
The “you gotta work” argument is especially evil because most people receiving Medicaid are already working, according to a December 2017 study by the Kaiser Family Foundation. 60 percent of adults receiving Medicaid work, and nearly 80 percent are in a family where at least one person is working. Workers on Medicaid tend — obviously — to be employed in low-wage jobs in which they still make so little that they still qualify for assistance, even if they work full-time. Their employers almost never offer work-based health insurance, because isn’t that what Medicaid’s for? And, not surprisingly, the rate of working adults on Medicaid is much higher in the South, home of “right to work” laws, hooray.
Of the 40 percent who aren’t employed, the study also found most faced “major impediments” to employment. This shit’s important, so we hope you won’t mind if we copy-paste the overview here:
The suggested guidelines would allow exemptions from work requirements for many of the folks who aren’t currently working, such as caregivers, people in school, or people with disabilities, but the catch is that those exemptions would be determined at a state level, using the guidelines states already use for eligibility in other programs with work requirements, like Temporary Assistance for Needy Families (TANF) or the Supplemental Nutrition Assistance Program (SNAP) — aka food stamps.
As the KFF study argues, throwing up more administrative barriers to people getting healthcare isn’t likely to be good for anyone. Applicants who would be otherwise eligible may have trouble meeting the new paperwork requirements for proof of employment (or of a qualifying exemption). It will also add to costs for the states, since they’ll be adding a new layer of bureaucracy to screen Medicaid recipients.
And if most people currently getting Medicaid are already working, or seem to have a good reason not to be working (which may win them an exemption from the work requirement), then why the hell is a work requirement needed in the first goddamn place? That’s simple: You gotta tighten the screws on poor people, because no matter what the reality is, Republicans just know life in poverty is an endless funtimes parade of free stuff. The goal here is to add more barriers to people living the high life on Medicaid, and the result will be fewer people getting the medical care that really can improve their job prospects. Topher Spiro, of the Center for American Progress, sums up the rationale in this excellent Twitter thread:
A 2016 study by the Center on Budget and Policy Priorities found that, for programs like TANF and SNAP, imposing work requirements didn’t actually improve employment among poor people.
The exception: programs that didn’t just require looking for work or showing proof of employment, but which improved education and good job-skills training. The best such programs actually did help more people escape poverty. But those cost money, so Medicaid told states they can’t use Medicaid funds to pay for them. (Though Maine Governor Paul LePage can use TANF funds for Christian after-school programs.) Why would we want to shower even more benefits on the poors when they’re already living it up with their refrigerators and color TVs and Obamaphones?
In totally unrelated news, President Donald Trump’s work day today begins at 1:30 p.m. Eastern.