The Mean-Spirited Republican Assault on Medicaid

Medicaid matters

Why do Republicans want to make Medicaid less accessible to poor families?

They typically argue that it’s too expensive and that it traps users in poverty, but their faux concern for the well-being of low-income Americans goes against all the evidence, including a new study published in the Journal of Health and Social Behavior last month finding that Medicaid coverage leads to economic mobility.

Nonetheless, last month, President Trump signed an executive order encouraging states to place new conditions on eligibility for the program, including work requirements. Three states—Kentucky, Arkansas, and Indiana—already have federal waivers allowing them to require that working-age adults be employed or enrolled in school or job training. Seven other states have asked for permission to apply such requirements.

The bureaucracy and red tape that work requirements create for states make the entire system harder to administer: Indiana originally set premiums at 2 percent of income for Medicaid enrollees, but has since asked to change its formula, since verifying incomes is too difficult and complex. Kentucky originally required different numbers of work-hours from its enrollees, but has asked to implement a flat requirement instead because of administrative concerns.

And that doesn’t even factor in the time squandered by individuals required to fill in extra paperwork confirming their eligibility for basic health insurance. The truth is that 60 percent of adults covered by Medicaid who aren’t elderly already have jobs, according to the Kaiser Family Foundation. Fourteen percent don’t work because of illness or disability, 6 percent are enrolled in school, and 12 percent say they’re caring for children or other family members. That leaves just 7 percent who don’t have a clear reason for not working—these might be people who are job-hunting unsuccessfully.

Despite its appeal to stingy conservatives, reducing levels of health insurance coverage has far-ranging effects on health, employability, and success—the Journal of Health and Social Behavior study compared kids born between 1980 and 1986 in counties where more low-income pregnant women were eligible for Medicaid coverage with those who had less access to Medicaid, and found that being insured at birth and during early childhood led to greater economic mobility by adulthood.

Previous studies have shown that giving low-income pregnant women access to Medicaid reduces infant mortality, and that coverage for poor families increases doctor visits and vaccination rates. Plus, benefits carry through to adulthood, resulting in reduced levels of obesity and diabetes. Kids with early-life Medicaid coverage also have improved educational outcomes, including better reading test scores, high school completion, and college attendance. One study finds that kids who started life with Medicaid coverage paid more in taxes by the age of 28.

The short-sighted Republican urge to save money by reducing Medicaid rolls ignores all of these health and economic benefits, as well as the growing popularity of the program among voters. There’s strong support for Medicaid expansion even in red states like Kansas, South Dakota, and Georgia, according to progressive think tank Data for Progress, and voter initiatives have succeeded in putting the issue on the ballots in Utah and Idaho for this coming November.

This week, healthcare advocates in Maine sued Governor Paul LePage (R) for ignoring the state’s successful ballot vote to expand Medicaid. The people want healthcare for all citizens, and Republican leaders dismiss that reasonable desire at their political peril.