Adios to a idiotically cruel — only Trump could create this oxymoron — relic of the reign from the president-that-mercifully-was.
President Trump looked at Medicaid, a health insurance program designed for the poor, particularly for poor dependent children and their just-as-poor parents, and thought: Aha! The poor may always be with us, but let’s prod them into working, or working more (since his aides must have told him that many poor Americans already work, just not at the wages that would keep them afloat). If only they worked harder, they would not only get more money, but greater family stability. The rhetoric, as well as the logic, was iffy.
But the intent was clear: no Medicaid for slackers. He encouraged states to draft “Medicaid work requirements.” To receive Medicaid, an applicant had to be working, applying for a job, or enrolled in classes. An end of the free lunch, a start to self-sufficiency for the poor.
States whose governors and legislators loved Trump loved this idea: it appealed to the people who blamed “the poor” for being poor. It also promised to cut states’ Medicaid rolls. In this Trumpian worldview, some of the poor would start working at jobs that carried with it health insurance. Others — the slackers — would be barred from Medicaid — which would lower the rolls. Only the poor who demonstrated “worthiness” to bureaucrats would get Medicaid. What a bonanza for budget-crunchers, all veiled in a conservative family-friendly rhetoric straight from George Orwell. The word du jour was “bridge:” Medicaid was to be a bridge to self-sufficiency.
Outside Trump-world, some recognized the mandate as idiotic. It would not spur people to work — many were already working. Many of the ones who were not working either could not find jobs, or could not work at the jobs that they found. The rule was cruel. Some “slackers” were sick: banning them from healthcare would make them sicker, if not kill them. We all — poor and nonpoor — need a retinue of preventive healthcare, from vaccinations to checkups to routine treatment for non-fatal illnesses. Most of us need medications — insulin for diabetes, heart drugs for atrial fibrillation, eye drops for glaucoma, anti-hypertensives for high blood pressure. The list goes on. To stay healthy, the poor need what the non-poor need.
The regulation was dangerous. Many diseases are contagious. Influenza, pneumonia, whooping cough, polio, now COVID — we deprive people of vaccinations at the risk of infecting a swathe of the country. As for bolstering families, the added strain of losing health insurance (and with it dependable healthcare) would exacerbate families’ stress.
Nevertheless, 12 states applied for the waivers, and were approved. A few more states applied, were waiting for a green light. Thus far an army of the appalled, including medical associations, have blocked the mandate in the courts. (One other argument against the mandate was that it wasn’t legal, hardly a deterrent in Trump-world.) Only Arkansas successfully implemented the mandate, and only for 10 months, until the court intervened. In that time, 18,000 residents lost Medicaid coverage.
The mandate has been wending its way through the court system.
So how refreshing to report news of the sane. At a time of COVID, when people are suffering lasting effects and need healthcare, President Biden has struck down this regulation in a series of states, starting with Ohio, Montana, Michigan and Wisconsin. Let the regulation fade into the archive of idiotic cruelty.
Joan Retsinas is a sociologist who writes about health care in Providence, R.I. Email retsinas@verizon.net.
From The Progressive Populist, September 15, 2021
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