The Trump Admin’s Approval of Medicaid Work Requirements Threatens the Lives of Poor People

Meaghan LaSala January 18, 2018

Forcing poor Americans to work in order to receive healthcare benefits could gut Medicaid and have devastating effects for those who rely on the program. (Getty)

Less than a month after the GOP passed its $1.5 tril­lion tax bill that will dis­pro­por­tion­ate­ly ben­e­fit cor­po­ra­tions and the super rich, the Trump admin­is­tra­tion opened the door to a pol­i­cy that could gut Med­ic­aid. New guide­lines issued on Jan­u­ary 11 will allow states to require recip­i­ents to work in order to receive health­care ben­e­fits through the program.  

In May 2017, Seema Ver­ma, the Trump-appoint­ed admin­is­tra­tor of the Cen­ters for Medicare and Med­ic­aid Ser­vices, issued a let­ter to gov­er­nors call­ing for inno­va­tions” to the health­care pro­grams in order to enhance human dig­ni­ty.” But as stud­ies have shown, the type of work require­ments encour­aged by the agency are inef­fec­tive in reduc­ing pover­ty, and cre­ate bar­ri­ers to life-sav­ing services.

In response to the administration’s deci­sion, the South­ern Pover­ty Law Cen­ter has said that it would file a legal chal­lenge. In a state­ment, the advo­ca­cy group called the work require­ment an effort to cur­tail access to health insur­ance cov­er­age for our nation’s most vul­ner­a­ble people.”

On Fri­day, Ken­tucky received approval from the Trump admin­is­tra­tion to enforce Med­ic­aid work require­ments, the first among at least 10 states cur­rent­ly seek­ing to enact the change. These most­ly Repub­li­can-led states include Ari­zona, Arkansas, Indi­ana, Kansas, Maine, New Hamp­shire, North Car­oli­na, Utah and Wisconsin.

Tajah McQueen is a par­ent and a mem­ber of Ken­tuck­ians for the Com­mon­wealth, an orga­ni­za­tion fight­ing for tax reform to fund edu­ca­tion and healthy com­mu­ni­ties. McQueen recent­ly enrolled in Med­ic­aid after being laid off from her full-time cater­ing job.

It’s insult­ing to assume that because I don’t have a job I don’t have dig­ni­ty or respect for myself,” says McQueen. If any­thing took away my dig­ni­ty, it was being let go of my job with­out expla­na­tion, and liv­ing in a soci­ety that doesn’t have bet­ter tools for peo­ple in these kinds of situations.”

It’s scary,” McQueen adds. I suf­fer from depres­sion and anx­i­ety. If I lost Med­ic­aid, I wouldn’t be able to afford to be able to pay for my med­ica­tion or go to ther­a­py. Not hav­ing my men­tal health under con­trol would hurt my capac­i­ty to apply for jobs, and han­dle the every­day life of being a parent.”

Begin­ning in July, Ken­tucky will require recip­i­ents of Med­ic­aid to work or vol­un­teer 20 hours a week and pay a pre­mi­um to con­tin­ue to receive ben­e­fits. Though some recip­i­ents will be exempt from the work require­ments, includ­ing preg­nant women, pri­ma­ry care­givers of a depen­dent, full-time stu­dents and the dis­abled, Miran­da Brown, out­reach coor­di­na­tor at the Ken­tucky Equal Jus­tice Cen­ter, argues that the changes will cre­ate bar­ri­ers for many who would oth­er­wise qual­i­fy and who have no oth­er means of obtain­ing cov­er­age. So many peo­ple who access Med­ic­aid live in rur­al areas where jobs and train­ing pro­grams are scarce and pub­lic trans­porta­tion is non-exis­tent,” says Brown.

Dar­rion Smith is a mem­ber of Black Work­ers for Jus­tice, a statewide orga­ni­za­tion of Black work­ers in North Car­oli­na, as well as a region­al Vice Pres­i­dent of the UE Local 150, the North Car­oli­na pub­lic ser­vice work­ers union. Both orga­ni­za­tions are active in the Moral Mon­days move­ment, which has vocal­ly resist­ed North Carolina’s refusal to expand Med­ic­aid under the Afford­able Care Act. Smith believes that North Carolina’s pro­pos­al to fur­ther restrict Med­ic­aid is direct­ly con­nect­ed to the GOP’s recent­ly passed tax bill.

This is an attack on poor peo­ple and work­ing-class peo­ple. It’s a way to cut back spend­ing on the Amer­i­can peo­ple in order to pay for tax cuts for cor­po­ra­tions and the wealthy,” says Smith. Look at the changes they made to TANF [Tem­po­rary Assis­tance for Needy Fam­i­lies] when they start­ed requir­ing peo­ple to show income. Stud­ies showed it did not increase hourly wages. It did not make employ­ment any more possible.”

The Cen­ter on Bud­get and Pol­i­cy Pri­or­i­ties has report­ed that adding work require­ments to cash assis­tance pro­grams such as TANF has had the effect of mov­ing peo­ple off of ben­e­fits with­out pro­vid­ing oth­er long-term, sta­ble income, leav­ing a sub­stan­tial share of fam­i­lies worse off.”

Bill Hig­gins, an advo­cate with Home­less Voic­es for Jus­tice in Maine, points to the impact of work require­ments on the SNAP food assis­tance pro­gram in the state, which led to more than 9,000 peo­ple los­ing ben­e­fits when the require­ments went into effect in 2015. While rates of food inse­cu­ri­ty are falling in most states, in Maine those rates are ris­ing, and cur­rent­ly sit high­er than the nation­al average.

Peo­ple will absolute­ly lose their ben­e­fits,” Hig­gins says of the new Med­ic­aid require­ments. He argues that peo­ple expe­ri­enc­ing home­less­ness need hous­ing and health­care in order to obtain a job. Get­ting peo­ple into a home need to be a first step. There are bar­ri­ers to employ­ment just from being home­less. Tak­ing away a ben­e­fit that helps them stay healthy is not going to help peo­ple get out of homelessness.” 

Home­less Voic­es for Jus­tice has ral­lied against oth­er pro­posed changes to Med­ic­aid in Maine, includ­ing manda­to­ry pre­mi­ums and co-pays. Hig­gins says the orga­ni­za­tion is com­mit­ted to fight­ing the new work require­ments as well.

Many sup­port­ers of these new work require­ments, includ­ing Kentucky’s Repub­li­can Gov­er­nor Matt Bevin, admit that such changes will result in peo­ple los­ing ben­e­fits. Bevin’s admin­is­tra­tion esti­mates that near­ly 100,000 peo­ple will lose access to Med­ic­aid in the five years after the require­ment goes into effect. This will­ing­ness to throw peo­ple off of cov­er­age demon­strates that sup­port­ers of the work require­ment are more inter­est­ed in gut­ting Med­ic­aid than in increas­ing either employ­ment or health­care access. 

The Trump admin­is­tra­tion, for its part, appears will­ing to ignore stud­ies show­ing that indi­vid­u­als thrown off of Med­ic­aid will have no oth­er access to care, and as a result could face seri­ous ill­ness and pre­ma­ture death. After push­ing through a tax bill that will throw 13 mil­lion Amer­i­cans off of health­care, these new changes to Med­ic­aid are fur­ther proof that the admin­is­tra­tion is will­ing to pur­sue an agen­da of tax cuts for the rich while low-income Amer­i­cans are forced to pay the price. 

Meaghan LaSala orga­nizes for health care jus­tice with the South­ern Maine Work­ers’ Cen­ter. Her writ­ing has appeared in Dis­patch, Alter­net, and YES! Magazine.
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