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”?