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All they have to do is run around the city while playing a horn

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Photo by Priscilla Du Preez on Unsplash

Arkansas’ Medicaid Works plan, which is aimed at limiting the reach of the ACA Medicaid expansion, is  working as intended.

Nannette Ruelle is watching three numbers tick downward as the year comes to a close. The first is the number of doses left in her Advair inhaler, which she normally uses three times a day to control her asthma. As of Nov. 17, she had 35 remaining. The second is the number of pills in her bottle of Gabapentin, which her doctor told her to take three times daily for chronic neuropathic pain in her feet and ankles. She had three as of Nov. 17.

The third is the number of days left until she can refill those prescriptions: 44. She was kicked off her Arkansas Works health insurance in September and will be locked out until Jan. 1.

Ruelle, 38, lost her coverage at the end of August due to Arkansas’s new requirement that certain Medicaid beneficiaries report their work hours to the state. For the past two-and-a-half months, she’s been carefully rationing both her medications, allowing herself a Gabapentin only when the nerve pain becomes so bad she fears she won’t be able to do her job. Ruelle works 25-35 hours a week at a chain restaurant in Little Rock, where she makes $9 an hour.

“It’s some serious stuff. They’re just playing around with people’s lives, and I don’t think it’s fair,” she said in a recent interview. “What if I wake up one morning and I can’t even function because my feet are hurting and I have nothing left?”

She’ll be another casualty in the Republican war on everyone who isn’t a white millionaire.

Ruelle said she first recalled hearing about the requirement in May, when she was working a minimum wage job at a different restaurant. The instructions on the notice she received from the state Department of Human Services were confusing, but she tried to do what the letter demanded.

“What happened was that I got my information and I tried to fax it to them. The fax wouldn’t go through, so I tried calling them, and I never got an answer on the phone. I went up there and they were out of the office,” she said.

When she got no reply after leaving voicemails and visiting her local DHS office, Ruelle said, she gave up. “I just quit trying, because you can only try so many times before it’s like, ‘OK, you’re closing the door in my face.’ ”

Ruelle’s attempts to reach DHS were unsuccessful in part because the agency only allows people to report their work hours through a website, rather than by fax, phone or mail. This online-only requirement is unlike any other reporting required by DHS. The agency places no such restriction on the way beneficiaries submit other information, such as a change of address — just their work hours.

Like Medicaid work requirements, the internet-only policy makes perfect sense in a state like Arkansas. That is, a state controlled by Republicans.

In its Nov. 8 letter, the federal commission criticized Arkansas’s insistence that beneficiaries use the web portal to report hours, considering the state has one of the lowest levels of internet connectivity in the nation. (Census data compiled by the Urban Institute, a D.C.-based think tank, show about 18 percent of households lacked home internet access in 2016, including no access through a cell phone.) Yet DHS has made many of its educational resources available only online or through social media, the letter noted.

The only thing missing is some administrative creep claiming that making it hard for people to keep their health insurance is actually good for the people who — ah, here it is.

DHS Director Cindy Gillespie has said the web portal is a means of pushing beneficiaries to gain computer literacy skills. “We need to help them get an email [address] and learn how to deal in that world, or they will never be successful,” she said in March.

It’s possible that Gillespie is merely a privileged POS who thinks that the ability to get an email and enter “that world” just sort of happens. Kind of like the Most Exalted Order of Armchair Nutrition Experts & Sundry Food Scolds think that the ability to prepare healthy meals just sort of happens. What’s more likely is she’s a privileged and sadistic POS who knows how to deliver the required doublespeak: A message that lets the victims know their suffering is intentional and that will satisfy other privileged POSes who don’t give a shit about poor people, but like to pretend they do.

However, DHS has devoted no additional resources to teaching beneficiaries those skills.

Frankly, fuck a bunch of skills. People need easy access to a working computer that has a reliable internet connection, and that goes double when a state ties access to health to internet access. And Gillespie can’t resist letting the everyone know that helping poorer Arkansans leap through extra hoops to prove they deserve not to suffer and die just isn’t worth the bother.

Gillespie also acknowledged at the time that online-only reporting would help the agency save money. “If you implement it in the old-fashioned way of, ‘Come into our county office,’ we would have to hire so many people,” she said.

Yes, of course. Why would a state that requires some people to prove they’re working in order to get health insurance want to create jobs? Sticking to the old-fashioned way of having people go to an emergency room when a chronic, manageable condition spirals into an expensive hospital visit will be much cheaper.

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