One of the bigger, and more heartening, surprises of the past year was just how fervently it turned out Americans supported health care for low-income people.
Republican politicians, after all, had been running against Obamacare – including its Medicaid expansion and income-based subsidies for buying insurance – from the moment the law passed. And the public appeared to back this agenda: The Affordable Care Act polled terribly.
Yet when push came to shove, and Republicans actually tried to dismantle the health-care law last year, Americans fought back. Hard.
They marched in the streets. They showed up en masse to town halls, shaming and shouting down lawmakers. They jammed congressional offices and phone lines.
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Even Trump voters, in focus groups, said they didn’t want to roll back Medicaid or other health coverage for lower-income people. Mostly, they just wanted in on that sweet, sweet Medicaid deal themselves.
Likewise, in broader polling, a majority of Republicans held favorable views of Medicaid and wanted its funding to hold steady or increase. Sizable minorities even said they supported single-payer or a public option.
Clearly “Obamacare” itself had a branding problem all these years, but on the more substantive question – whether it was government’s role to make sure Americans had health-care coverage – Democrats had won the fight.
Or so it seemed. Republican officials have, a bit less conspicuously than last summer, fought on.
Unable to roll back Obamacare’s health-care expansion legislatively, they’re now doing so administratively, through a series of technical, boring-sounding regulatory changes.
This GOP effort ramped up last week, when the Trump administration began allowing states to erect new barriers to Medicaid eligibility.
In the half-century since Medicaid was first created, eligibility has always been based almost entirely on financial circumstances such as income and assets; the program’s goal, after all, was to help less-well-off Americans obtain medical care. Last week, though, the Trump administration announced that it would start allowing states to impose other requirements on Medicaid recipients, including proof that they are working, looking for work, volunteering or in school.
“I was raised with a mind-set to work, give an honest day’s work for an honest day’s pay,” Kentucky Gov. Matt Bevin (R) said at a news conference announcing that his state was the first to receive a waiver allowing Medicaid work requirements. “It’s the very same thinking that we want to bring to people here in Kentucky that are able to participate.”
But there’s no reason to think, in Kentucky or other states itching to add work requirements, that there are legions of Medicaid loafers. Nearly eight in 10 Medicaid-enrolled nonelderly adults already live in working families, and most (60 percent) are working themselves, according to the Kaiser Family Foundation. Most who are not working report major impediments to their ability to get a job, such as illness, disability, school enrollment or caregiving responsibilities.
But that won’t necessarily protect eligible low-income people from being kicked off Medicaid rolls anyway.
Verifying that beneficiaries meet work requirements will impose a huge and costly new administrative burden on states and also on the working poor. As the Trump administration letter approving Kentucky’s work requirements acknowledged, the state’s Medicaid phone lines are already overwhelmed. If working Kentuckians are unable to cut through the red tape, they can get locked out of the system for six months.
The Trump administration argues, somewhat confusingly, that the new work requirements will actually improve public health. Why? Because they’ll encourage more poor people to find jobs, and employed people tend to have fewer health problems.
This likely gets the causality backward, though, given how many Americans report illness as a barrier to getting or keeping a job.
Focus groups and state-level studies have found that Obamacare’s Medicaid expansion helped lower-income people gain work or remain employed; inversely, reducing long-term access to physical, mental and substance-abuse treatment is likely to hurt both health and employment prospects.
If the Trump administration truly wants to help more Americans find jobs – a goal that both parties can surely get behind – there are far more effective tools than taking away health care. Investing in skills, apprenticeships and job-matching services, for instance. Or expanding the earned-income tax credit, a historically bipartisan program curiously absent from the recent tax bill.
Instead, they’re still fixated on dismantling Obamacare, through this backdoor regulatory repeal.
Republicans are counting on the notion that a raft of wonkish-sounding waivers – unlike last year’s splashy, failed Trumpcare legislation – will inspire no riots in the streets, no rowdy town halls, no phone-line-jamming and no mass mobilization to protect health care for the nation’s most vulnerable.
Who wants to prove them wrong?
The Washington Post