Latest Cruelty Decree from Trump Admin: A-Okay for States to Impose Work Requirements for Medicaid

This is low-key heinous, by Trump standards, but worth getting mad about. From the Times:

The Trump administration said Thursday that it would allow states to impose work requirements in Medicaid, a major policy shift in the health program for low-income people.

Federal officials said they would support state efforts to require able-bodied adults to engage in work or other “community engagement activities” as a condition of eligibility for Medicaid.

Just like the rest of the Republican legislative agenda, this will result in more poor and unemployed people getting screwed. In this case, it will mess with their healthcare. Apparently, Medicaid officials in 10 states requested permission to run “demonstration projects” meant to put the onus on Medicaid recipients to prove that they were either employed or engaged in community service of some kind. Here’s the inevitable justification quote from Seema Verma, federal administrator of Medicaid and Medicare:

“Our fundamental goal is to make a positive and lasting difference in the health and wellness of our beneficiaries, and today’s announcement is a step in that direction.”

Inherent in this quote, and in the broader policy, are two fundamental, age-old Republican beliefs:

1. Healthcare is not a right-it is something you have to earn.

2. The poor and unemployed have reached those states because they are lazy.

If you operate by that logic, then yes, I suppose it follows that one good way to get all those lazy people to contribute to society is to take away something essential. And maybe—who knows?—maybe Republicans actually believe this will somehow improve the world, rather than cast these already suffering people into deeper misery. I doubt it—I think they’re just cynical—but maybe.

Seriously, read this, and try not to gag:

“Productive work and community engagement may improve health outcomes,” Brian Neale, the director of the federal Medicaid office, said Thursday in a letter to state Medicaid directors. “For example, higher earnings are positively correlated with longer lifespan.”

In addition, Mr. Neale said, researchers have found “strong evidence that unemployment is generally harmful to health,” while employment tends to improve “general mental health.”

It would be funny if it weren’t so tragic—yes, it’s great for your health in America to be rich, because it means you can afford healthcare. What doesn’t follow from that, not at all, is that depriving those who can’t earn lots of money of critical health coverage will somehow turn them into rich people.

Basically, you have to decide which story seems more likely to you:

Story one: Person with few job opportunities, no money—maybe with chronic mental or physical health problems including disabilities, maybe a previous incarceration, maybe stuck in a rural area, maybe a caregiver to his/her own family—depends on Medicaid to help stay financially afloat when a health crisis hits. The new work requirement reduces or removes this coverage, and life gets a whole lot worse.

Story two: In accordance with the magical bootstrap theory, lack of Medicaid kicks all the lazy poors into gear, everyone gets a job, health outcomes improve, poverty goes down.

When you further consider that a large number of Medicaid recipients are poor children, pregnant women, seniors, and the disabled, this looks even more cruel.

If any eligible recipient is denied based on the new work criteria, it’s likely there would be a swift challenge in the courts.