Trump’s Medicaid Work Requirement Is Grotesquely Bad Policy

Emma Sandoe is, as always on this subject, excellent:

Eight in 10 Medicaid beneficiaries of working age already live in working families. Recent analysis by the Kaiser Family Foundation has found that the most Medicaid beneficiaries who are not working are sick or disabled (but do not meet the rigid definitions of disability outlined by the Social Security Administration), or they are taking care of their family who may be elderly, sick or children that need care. Many more are in school or are retired.

These people have valid reasons for not working and taking away their health insurance will likely make their health worse or worsen the health of the people that they are caring for. The administration has created a solution to a problem that does not exist.

This policy will make it more difficult for people who are eligible for Medicaid and are working in low-wage jobs to be enrolled in the program. Navigating the complexities of health insurance bureaucracy is difficult for anyone. This policy adds another layer of complexity to the system. Now, beneficiaries will have to take additional steps when applying for coverage, as well as monitor and ensure their state government is accurately recording their information to receive the benefits they are already eligible for. Think how the country would respond if Medicare beneficiaries had to regularly prove that they were aging to keep their Medicare cards.

In reality, IT systems don’t always work, mail gets lost and people working two to three jobs to get by and still making little money may not have the time to correct the paperwork. Healthy people who want to get preventative health care will drop out of Medicaid because the additional burden is too high. These people may miss cancer screenings and diagnosis of chronic conditions.

The purpose of any insurance is to protect against financial devastation. Rigorous and recent research shows that Medicaid coverage not only improves a beneficiary’s health, it protects low-income people against bankruptcy and financial loss. These important protections have reduced extreme poverty and allowed many people opportunities to get out of poverty.

The administration has tried to make this policy more palatable by making exceptions for people who volunteer or have a severe disability. But this policy is so heavily pushed by the administration and Republican states because they think it will reduce the number of people on Medicaid. When we’ve tied work to other government run programs, it does little to increase work. In fact, we’ve seen the opposite: that access to health care can make it easier for people to find jobs. We’ve seen that when people don’t have access to needed medications it is harder for them to find jobs.

The point about how adding further conditions creates bureaucratic impediments that inevitably cause even eligible people to lose their insurance is particularly important.

And this avoidable suffering and misery has become a pillar of Republican policy. A collaboration between one of the worst decisions in the history of the Supreme Court of the United States and Republican state legislators had denied Medicaid to millions of people. A Republican Congress came frighteningly close to enacting massive Medicaid cuts in order to fund a massive upper-class tax cut. And now, having failed to gut Medicaid, Trump and various state legislatures are lashing out against some of the most vulnerable people in society. This is what Republican health care policy is, and it’s simply vile.