Have you heard that the Trump administration is likely about to approve a waiver for Governor LePage’s administration to kick a bunch more people off health care? Have you heard about the “debate” over work requirements? Are you wondering what the heck is going on? Buckle up. Here is the GIFsplanation you’ve been waiting for.
OK. Let’s start at the very beginning.
In 1965, President Lyndon B. Johnson* authorized Title XIX of the 1935 Social Security Act, which signed Medicaid (healthcare for low-income people) and Medicare (healthcare for seniors) into law.
Medicaid was designed to provide health coverage for low-income people–at minimum, for kids in low-income families, seniors, pregnant women, and disabled people. Over the next 50 years, Medicaid kept millions of people out of poverty and saved huge amounts of money in health spending.
As one of the most smashingly successful programs in American history, it was clear it needed to grow. However, there were only a few basic rules that states had to follow to administer the program, so there was a lot of variation in who was covered. Until…
The Affordable Care Act standardized rules for determining eligibility and expanded Medicaid to people living in families that make less than 138% of the Federal Poverty Level (which is really low–we’re talking $24,600 a year for a family of four).
This was a huge deal, and one of the cornerstones of the ACA…
…until the Supreme Court struck down the provision that required states to expand Medicaid (or else lose their existing Medicaid funding)–making expansion effectively optional.
Which meant that some states with Republican governors that were already the worst at administering Medicaid were precisely the states now dragging their heels to accept the huge influx of federal dollars to make sure people had health care.
This story is going to get worse before it gets better. But we’ll get there. Hang in.
Flash forward to 2017: The Year Republicans Tried and Failed Like 65 Times to Repeal Obamacare After Campaigning Against It For Eight Years. Their core objective? Decimate Medicaid.
As you know, they failed.**
**Republicans will still of course, 100 percent, try to force major cuts to Medicaid (among other programs) following their $1.5 trillion tax giveaway to the wealthy.
Not to be deterred from their mission t0–in the words of one of my favorite political journalists, Sean McElwee–“brutalize their own voters by denying them health care,” Republicans went searching for another solution.
And they came up with a sneaky, back-door way to kick hundreds of thousands of poor Americans off healthcare: Section 1115 Demonstrations.
Section 1115 is a waiver that the federal government can grant to states that want to test new approaches for Medicaid. To get approved, the Department of Health and Human Services has to determine that the initiative is an “experimental, pilot, or demonstration project” that “is likely to assist in promoting the objectives of the program.”
Under the Obama administration, this was interpreted to mean that that at minimum, people had insurance coverage, i.e. the whole point of the program. But now the Trump administration is all like, “Did you say experiment??”
“How about,” they said, “we change the standard so states can kick tons of people off insurance by putting in place punitive, ineffective, and byzantine ‘work requirements’ and call that an experiment?”
First of all, work requirements do not actually “work.” There is zero evidence to support claims that work requirements make any meaningful impact on people’s employment or wages. Actually, two decades of studies show that these requirements increase poverty. That’s because when you kick people off healthcare for not filling out complicated paperwork correctly (a hallmark of the work requirements program), guess what gets worse? Their health–and therefore their ability to work. It’s completely upside down and makes no sense.
Secondly, nearly 80 percent of people on Medicaid are already working or in a family with someone working. Of those 20 percent not working, 36 percent are disabled or sick, 30 percent are caretakers (aka the great invisible laborers of our society), 15 percent are in school, 9 percent are retired, and 6 percent are looking for work. That leaves three percent–out of 20 percent!–of people they are supposedly talking about when they say things like “able-bodied adults.” Quick math check: that’s a whopping 0.6 percent of people on Medicaid.
Soooo, if we’re talking about a completely ineffectual program that in theory only applies to a tiny, tiny percentage of Medicaid recipients, why are they pushing this so hard?
Clue #1: Work requirements for Medicaid are being promoted by the same set of people who think it’s a good idea for the federal government to mail poor people a predetermined packaged food once a month, eliminate all assistance for families struggling to heat their homes in the winter, and evict hundreds of thousands of families from public housing.
Clue #2: This quote from House Speaker Paul Ryan discussing work requirements (emphasis mine): “We have got this tailspin of culture, in our inner cities in particular, of men not working and just generations of men not even thinking about working or learning to value the culture of work, so there is a real culture problem here that has to be dealt with.”
Wait, so are you saying this is part of the decades-long strategy by the conservative right to racialize social services like food stamps and welfare so that struggling white people vote against their own economic self-interest, paving the way for powerful elites to cut these programs to death to make room for massive tax cuts and corporate benefit?
Dang. Got it. OK, so can we please pull out of this tailspin and move towards what can be done?
#1: It is a BFD that Maine voters overwhelmingly passed Medicaid expansion in November (The first state to do so by referendum!). Maine voters said clearly, “We want MORE health care, not less.”
#2: There is a very strong argument that work requirements are illegal, and it’s entirely possible they will be thrown out by the courts. There are pending lawsuits in Indiana and Kentucky, while in Maine the formidable attorneys at Maine Equal Justice Partners are prepared to sue if necessary.
#3: The upcoming 2018 election is critical. The governor appoints the head of Health and Human Services and that will make a difference for implementation. Plus, the more candidates running on a visionary health care platform, the stronger the message. During the Obamacare debate, universal single-payer was off the table. Under Trump, we’re now talking about about Medicare for All. Let’s bounce forward from this disastrous idea of work requirements to health care for everyone!
If you want to learn more, here’s a good place to start. If you want to contact your legislators and tell them to stay vigilant on this issue, that will only help. If you have a story to share–i.e. are currently on Medicaid and might lose coverage, or know somebody who fits that criteria–please email Victoria Rodriguez at [email protected]. You can also take this short survey to determine whether your coverage is at risk.