Indiana–Ignoring Law, Pursing Bad Policy

The current push by the Trump Administration to add work requirements to Medicaid is stupid and unworkable–not that Trump understands or cares. It is also likely to be costly–adding another condition to receipt of health care is yet another bureaucratic task, another box to be checked off by someone who must be paid to do the checking.

People knowledgable about the program point out that virtually all Medicaid recipients fall into one of three categories. They are elderly, disabled or children. (This is an administration that doesn’t listen to experts, of course. The President’s “gut” is the basis of policy, not evidence or fact.) The consensus of opinion from experts is that it would cost far more to administer the requirement than it would save by throwing a very few people off the program (unless, of course, the requirement is applied more broadly than justified).

And that brings me to my own State of Indiana, where ideology consistently defeats both facts and common sense. Indiana is continuing to pursue work requirements despite the overwhelming evidence that it’s a stupid policy and despite the fact that recent federal court decisions hold that it violates federal law.

On Wednesday, a judge struck down Arkansas and Kentucky’s Medicaid work requirement programs, throwing the future of the conservative health policy — and Medicaid expansion at large — into question.

U.S. District Judge James Boasberg’s ruling blocks Kentucky from implementing its program — which was the first approved by the Trump administration in January 2018 — and puts an end to Arkansas’ program, which has been running since June and has led to the loss of health care for tens of thousands of people.

In a case expected to reach the U.S. Supreme Court, Judge Boasberg ruled that “Medicaid is an entitlement” and that the defendants “did not address … how the project would implicate the ‘core’ objective of Medicaid: the provision of medical coverage to the needy.”

A number of Republicans echo the position taken by (increasingly unpopular) Kentucky Governor Matt Bevin. Bevin has vowed to end Kentucky’s entire Medicaid expansion program if he can’t implement the work requirements. That  would mean 400,000 people would lose their health insurance–but punitive ideology is clearly more important to Bevin than the health care of 400,000 citizens of his state.

Gives “my way or the highway” a whole new emphasis….

What makes this position especially egregious is that it isn’t prompted by cost concerns; it is entirely motivated by opposition to government-provided health care even when the federal government is paying for it.

Work requirements for Medicaid, the nation’s health insurance for the poor, sprang up after the passage of the Affordable Care Act, President Barack Obama’s signature legislation. The law allows and helps states offer Medicaid to more low-income people. The federal government initially pays 100 percent — and eventually 90 percent — of the costs of expanding eligibility to people earning 138 percent of the federal poverty line.

Most of the early adopters of Medicaid expansion were Democratic-led states. Some Republican-led states have slowly expanded coverage, but most of them have added a work requirement for nondisabled people — a policy that the Obama administration repeatedly rejected. Under the Trump administration, CMS has approved work requirement waivers for Arkansas, Arizona, Indiana, Kentucky, Michigan, New Hampshire, Ohio and Wisconsin.

I will never understand the Republican animus toward the poor. Whatever happened to the Christian admonition about caring for “the least of us”?


  1. More of the same from the Republicans
    Social Security – Became law with near ZERO votes from the Republican
    Medicare – ”
    Medicaid – ”
    ACA/Obama – ”
    They are truly hateful jerks – BUT they are consistent
    They ONLY care about the big money folks. ONLY
    The Republican Mantra “I’ve got mine. Screw you”

  2. The falsehood of republicans being in any real sense “christians” went out the window when they nominated, voted for, and are in far too many cases are still supporting “Individual #1”. That many of them claim “God” wanted trump to be POTUS ignores that God also wanted Obama, the Bush’s, Regan, Carter etc etc. and that God gave us free will to do stupid things like elect trump or kick those unable to work off systems intended to help them.

  3. Here is a sneaky, questionable loophole in the Medicare system I just discovered; the only possible reasoning behind this is to add to the expense of our out-of-pocket Medicare coverage through the health care insurance system.

    “Medicare Part D, also called the Medicare prescription drug benefit, is an optional United States federal-government program to help Medicare beneficiaries pay for self-administered prescription drugs through prescription drug insurance premiums (the cost of almost all professionally administered prescriptions is covered under optional Part B of United States Medicare).[1] Part D was originally proposed by President George W. Bush in 2003 and enacted as part of the Medicare Modernization Act of 2003 (which also made changes to the public Part C Medicare health plan program) and went into effect on January 1, 2006.”

    In my search for health care which would actually be available to me due to limited driving abilities; I believed I had found the solution only to learn of the Medicare Part D loophole which increases health care premiums. Medicare Part D is NOT mandatory but…if you enter an insurance provider with some prescription coverage you are charged a Medicare D Late Enrollment Penalty (LED) which is added to your premium. Those of us with few prescription needs, believing it wasn’t feasible to add the Part D cost to our monthly Medicare premium, are penalized if we enter an insurance program with some prescription assistance. (I researched this in depth yesterday.) Evidently the Medicare Advantage (Part C) insurance coverage I have been in since 2001 did not include Part D in the small prescription coverage they provided till all prescription coverage was dropped a few years ago by I.U. Health Care.

    Medicaid in Indiana covers the Medicare costs for those whose low income qualities them for the assistance; this would include the Medicare Part D for those who opted for that coverage prior to qualifying for Medicaid. This goes back to Republican President George H.W. Bush; it increases the cost of covering Medicaid recipients who qualify for Medicare coverage and the Republican states are now trying to find a way out of paying for the assistance they set up.

    “I will never understand the Republican animus toward the poor. Whatever happened to the Christian admonition about caring for “the least of us”?”

    Neither will I, Sheila, neither will I; especially after working in the vast community service system in this city under Mayor Bill Hudnut (Republican) until the election of Reagan.

  4. To answer Sheila’s question, Republicans don’t even talk a good game at being Christian. They congratulate themselves for going to church on Sunday (those who go, at least), but haven’t internalized the messages in the New Testament – if they have ever read any of it, that is.

  5. The work requirement goes hand in hand with the drug testing requirement for those receiving public assistance. Neither program makes any fiscal sense, but saving money is not the goal. These programs are specifically designed to hurt the poor and make the Republicans and their supporters feel superior to someone.

  6. Indiana got a Work Requirement Waiver approved for Medicaid Expansion recipients back in March 2018 and it started in January 2019. Managing it will be very expensive and burdensome for the state, but the Republicans would much rather spend money to keep people from getting much needed health care than providing that health care that they cannot otherwise afford.

    It is actually even more evil than just a work requirement. If people are unable to find work, they must volunteer a certain number of hours per month. When the program is fully phased in that number of hours will be twenty. This means that some people will be forced to PAY money (that they may not have) to travel to some place just to volunteer their time.

    The Republicans are so evil and hard-hearted that they will stop at nothing to kick people off of a health insurance plan that they so badly need.

    Here is a link that describes the Indiana ACA Medicaid Expansion Work Waiver and how complicated it is, in case anyone is interested in reading about the extent Indiana went to in order to kick people off of the program or make it so difficult that they would just give up.

  7. Ah yes, the prosperity gospel. If you’re rich, God must like what you’re doing. And well…if you’re not rich….well, you see where I’m going. What a vomitous theology.

  8. I cannot grasp the reasons for Republican desire to rip health care away from the poor–or food stamps for that matter–for the same reasons I cannot fathom why serial killers, child rapists and arsonists do what they do. Their reasons simply fall outside of my ken. I cannot even IMAGINE why someone would act that way–and yes–I’m comparing Republicans to serial killers, child rapists and arsonists. Since we can’t lock Republicans up for their misdeeds we need to vote them out–Every last cursed one of them.

  9. no matter how its played,again its a republican scam. pushing for private insurence for profit. people who have worked all their lives,can not just start over. I come from union member household, my grandfolks had AFL-CIO insurance, and it covered the whole family,and then some. co pays didnt exist,and deductables were covered. now we have a give away administration to,the wealthy. why in hell we dont have the media screaming,or is this is just another mouth piece supporting the demise of the American worker,in any, institution. I was in houston this past week in a working class area,mainly of color. all i see is people working and supporting whats left of our economy. but what really gets my hair up, is when a bus load of people in public transport, as they drive by,all staring into a infinate glass wall,pacified,and hypnotized at what they are watching/doing. little to any,would have a clue of how this all works against them,as they just drive by…and were suppose to find a electrate who is informed? best wishes..

  10. Sheila rightly points out that the work for coverage Republican plan at the state level is not prompted by cost concerns but rather by an ideological position – that Republicans at the state level are simply opposed to government provided health care even when the federal government is paying for it; so since both the state and federal governments (illegally in view of recent district court holdings elsewhere) is trying to stiff a very vulnerable population, perhaps we the people should take a credit on our state and federal income taxes for the proportionate amount they would have had to pay in a tit for tat “you don’t pay – we don’t pay” response.

    An illegal move under existing law? Yes, but so is that of the government per current judicial holdings. A tempting response, but the better response is to file suit using the rationales of holdings in the cases Sheila has cited from other jurisdictions. We can take things in our own hands on other issues down the road, like constraining Herr Trump’s dictatorial ambitions etc.

  11. The Reactionary Right Wing Republicans want to destroy any type of Government Medical benefits. Government Medical Care is Socialist and must be opposed on ideological grounds. Even though Single Payer – Universal Health Care would be far more efficient, cost effective and deliver Health Care to all Americans from birth to death it is opposed on a ideological basis.

    The Evangelicals oppose government Health Care since they view our secular government as the enemy. Then you have the Red Neck Republicans who imagine people of color getting free health care at their expense.

    If people have to suffer and die to maintain ideological purity – then they are collateral damage. After all if you cannot afford health care -too bad so sad -There must be something wrong with you. Over the last two years, at least 128,000 kids have been removed from Medicaid coverage through TennCare or CoverKids, many without their parents’ knowledge.

    The ONLY way out of this situation is Universal – Single Payer Health Care for all Americans. The Vultures of the Corporate American Healthcare system have begun their fight against Single Payer. These vultures have their allies in the Democratic Party.

  12. The above commentary today confirms that the Republican party has outlived its usefulness – if it ever had any – and must be voted to the back of the room everywhere. Their only visible purpose is to starve the working classes and turn our nation into a kleptocracy whereby only the billionaire class rules.

    Our votes have NEVER been more important.

  13. It’s way past time for universal health care coverage, as ML says.

    Here’s one reason why: When I was solely writing my annual income fell below the poverty level. I qualified for Healthy Indiana Plan (HIP). It’s actually a superb health plan.

    When I got hired to work at the State, their health plans was so bad, it cost me $2,500.00 the first year. Insulin is expensive and a high deductible plan cuts almost 10% off from annual wage.

    It actually cost me money to go back to work. I was financially in better shape working minimum hours while being covered by HIP.

    This is why we need universal healthcare. When the State of Indiana offers better programs to the impoverished than they do to their own employees, there is an injustice which slaps their work requirement in the face.

    If employers offered great health plans (which most do not), there would be a great incentive for people to work. Furthermore, employers clamor to their Chamber that they cannot find employees to fill open positions. Supposedly, we still have a labor market. Maybe they should raise wages and provide better benefits. High deductible plans with low wages does not make you an employer in demand.

    Employers are the ones pressuring for this work requirement. Instead of offering higher wages and better health care to ATTRACT workers, they want their GOP reps to force people to find “work”.

    Even local economists are recommending that if employers can’t find employees for an open position, they need to make themselves more attractive (higher wages with excellent benefits and perks).

    The idealogues firmly believe that HIP recipients are sitting at home doing drugs versus being productive members of society. I’ve heard this utterance many many times.

  14. We need to have a “work requirement” for rich folks who clip coupons or manipulate financial transactions before they can get the fancy tax breaks they lobbied for. Likewise, there should be a drug testing requirement for all millionaires and above for the same!

  15. The only effective Counterattack to these Republican Tactics is to elect a Democratic President, Senators and House who are committed to Universal -Single Payer Health Care. No more of this garbage of let’s repair ACA.

  16. The official posturing is that this requirement will only be a burden to those “lazy slackers” who are utilizing Medicaid while not working or qualifying for an exemption. But the reality is that it will burden nearly all of the other Medicaid recipients as well.
    Those already working at poverty wages must ask their employers to sign off on their time. Many will comply willingly…but some will use this new power to further exploit their workers, or hold their Medicaid status as leverage.
    Those who are not working due to caring for a disabled child or relative must jump through a hoop to have that status certified and recertified regularly.
    And this requirement gives a new tool to the private insurers who “administer” the program. They already know who the “high cost users of medical care” are. Wouldn’t it be just convenient if some of those folks “accidentally” lost their paperwork or didn’t get it processed on time? Sure, there’s an appeals process to get them requalified (maybe) but in the meantime, it’s an excuse to deny claims. I had a discussion with State Sen Ruckelshaus about this very possibility, and his response was “I would hope that won’t happen” – so that should make you feel more secure, doesn’t it? “There will be audits after the system is implemented”, and history tells us that the auditing function will be underfunded and understaffed, so good luck with actually tracking this. And good luck to those who lose their coverage in the meantime, I’m sure they will be happy to know that “someone” “might” pay a penalty or fine at some point in the future. We “hope” you’re not dead by then.

  17. Mary,

    Your post would appear on the surface as pure cynicism, but it’s actually 100% accurate. Especially, the strategy of bootstrapping the regulators. In Indiana, much of these services are outsourced. In some cases, the work is outsourced to a company who then subcontracts to other providers. In effect, the state is paying one company to oversee a contract to another company.

    Very efficient…NOT!

  18. My son has epilepsy and has seizures every day. I would like to know how he can go to work, drive, hold down a job when he seizes and is out of it for around 3 to 4 hours after each seizure. What employer is going to tolerate that? What employer is going to hire someone knowing that they could have a seizure in their work place? What employer is going see him as something other than a huge liability? The legislators have always had insurance at little to no cost and have never been faced with the impossible choice of purchasing medication or paying rent.

  19. Thanks Sheila,

    All the family advocates that I worked with on a daily basis while I was in my previous slot at Riley Hospital for Children (now Riley Children’s Health) are justifiably livid about this rancid idea and if they’re livid I am immediately livid as well. If this is implemented, God forbid, it will hit the ‘special needs” community like an atomic bomb. The rub is that while the kids are covered the parents are often in a precarious position given the level of care they need for their child or children and balancing that with making a living and garnering their own health insurance. Often or at least before the ACA parents often went without health insurance or had serious limitations on it if it was through an employer.

    If Trump tries to tamper with the Medicaid Waiver program that is aimed directly at supporting children with special medical needs I will make a one man pilgrimage to the White House myself to protest out in front on Pennsylvania Avenue.

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