It’s a peculiar feeling, as you age and perhaps gain a brief sense of the place in which you reside through this particular point in human history. Like paddling in the trough in-between the wave ahead of you and the one quick to follow, in the words of Peter Pan author J.M. Barrie, “all of this has happened before, and it will all happen again.”
Thus we find ourselves revisiting the eternal recurrence or fighting pauperism with the time clock. The Trump administration and congressional Republicans, after a year of fits and starts that only triumphed in a plan to blow up the federal deficit for tax cuts overwhelmingly benefiting the wealthy, now began their next visionary project: sticking it to the most vulnerable Americans.
The Trump administration issued guidance to states early Thursday that will allow them to compel people to work or prepare for jobs in order to receive Medicaid for the first time in the half-century history of this pillar of the nation’s social safety net.
The letter to state Medicaid directors opens the door for states to cut off Medicaid benefits to Americans unless they have a job, are in school, are a caregiver, volunteer or participate in other approved forms of “community engagement” — an idea that some states had broached over the past several years but that the Obama administration had consistently rebuffed.
This is an administrative move many health care folks expected was coming, especially since the director of the Centers for Medicare and Medicaid Services, Verma Seema, outlined the federal government’s intentions last November. It was then that she described the Obama administration’s refutations of state requests to add work requirements to Medicaid a “soft bigotry of low expectations.” Moreover, that the “thought that a program designed for our most vulnerable citizens should be used as a vehicle to serve working-age, able-bodied adults does not make sense.”
It’s important to understand the principle behind this idea, because forcing poor folks to work for health care doesn’t actually address any acute problem to match the rhetoric. There is no dearth of layabouts sitting on the employment sidelines because they can see a doctor. The vast majority of people enrolled in Medicaid are elderly, children, or disabled.
And as Drew Altman explained last April when this subject came up, “most people on Medicaid who can work already are.” Of the number that don’t work; most are sick, too disabled to work but without qualifying for often stringent standards for disability benefits, are a caregiver themselves, or going to school. The greatest percentage of those who cannot cite the aforementioned reasons for not working aren’t coddled millennials, but those aged 46 and older.
Again, this isn’t about sheer numbers. If you live in Alabama, Florida, Georgia, Idaho, Kansas, Maine, Mississippi, Missouri, Nebraska, North Carolina, Oklahoma, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, or Wyoming and don’t have a child, earning a single dollar a year disqualifies you from enrolling in Medicaid. States looking for such ‘flexibility,’ if we take it to mean the ability to limit enrollment, do in fact already possess it.
What Republicans are looking for is punishment, in principle, and budget savings, in practice. They’re not seeking to prevent idleness that benefits from public assistance, else why would we treat capital so favorably? Nor are they looking to construct a “capricious bureaucracy,” when it would simply be a continuation of the status quo. They are writers submitting the next chapter in a long treatise advocating malicious regulation of the poor, for a doctrine that mandates punitive treatment for the least among us.