by THE EDITORIAL BOARD · January 11, 2018
When Ohio and Michigan expanded their Medicaid programs to broaden coverage, residents who became eligible found it easier to look for work, according to studies by the Ohio Department of Medicaid and the University of Michigan. That’s because having Medicaid gave them access to primary care doctors and prescription medicine that helped them live normal lives and get jobs.
That’s how you help people in the real world. The Trump administration said Thursday that it would get poor people to work by letting state governments deny them Medicaid if they don’t have a job.
The Centers for Medicare and Medicaid Services argues that this draconian step will encourage more Medicaid beneficiaries to get a job and thus “promote better mental, physical and emotional health.” There’s no evidence that this is true, and the data from Michigan and Ohio shows that it contradicts the truth. There is good reason to worry that fewer people will have a job in states that adopt this cruel policy.
Arkansas, Indiana, Kentucky and seven other states are seeking waivers from federal law to initiate the policy, and the agency says it is ready to grant them the waivers in the coming days if the states meet certain minimal conditions, like exempting people who are pregnant, disabled or caring for family members.
The new policy would be attempting to solve a problem that doesn’t exist. About two-thirds of Medicaid beneficiaries are either seniors, disabled people or children. Of the remaining one-third, nearly 80 percent are in families with at least one working person and 60 percent have full- or part-time jobs, according to the Kaiser Family Foundation. This policy change is merely a bureaucratic obstacle to keep poor people from obtaining Medicaid. Eligibility for the program varies from state to state, but the national median income limit for a single person to qualify for Medicaid is $16,642 a year.
Republican lawmakers who have demonized the program as welfare for “able-bodied adults” have long sought to require Medicaid beneficiaries to work. Those lawmakers have been particularly angry about the expansion of Medicaid under the Affordable Care Act, which they have been trying to repeal since it was passed in 2010.
Taking Medicaid away from people who are out of work would damage some of the most vulnerable people in the country. Among them are residents of rural areas who are struggling with opioid addictions and, as a result, cannot hold down permanent jobs. It will also hurt people who, through no fault of their own, lose their jobs and are not able to quickly find another one because they live in a depressed area or because economic changes have made their skills less valuable. Then there are people with chronic conditions like diabetes who do not qualify for disability, but are often unable to work.
“Even though sometimes I can get a job, you’ve got to understand — sometimes I can’t even walk,” Jimmy Brunson, a diabetic in Arkansas, told The Times last year.
It is not clear that the Trump administration can legally allow states to impose a work requirement. Experts say federal law allows the government to grant waivers only if they help to advance the aims of Medicaid, which is to provide medical care to low-income people. It strains credulity for the administration to argue that denying health insurance to people on the basis of their employment status meets that test. Public interest groups acting on behalf of Medicaid recipients are likely to challenge such waivers in court.
Maybe Americans shouldn’t be surprised that this administration wants to take health care away from the poor, given that it has spent so much time trying to wreck the A.C.A. But they should be angry.