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Medicaid and work

When government handouts go to layabouts, it’s not surprising that some people get angry. That’s why imposing a work requirement on trust fund babies, the next-generation of ultra-wealthy, hedge fund managers, big-oil executives and all the others who just scored big on the Republican tax bill makes a lot of sense. Oh, sure, they may have trouble finding meaningful labor, but surely there’s a community engagement opportunity out there somewhere for the folks who just got the lion’s share of the largesse that’s expected to add $1.5 trillion or more to the national debt.

Wait, you say, that would be an outrageous burden to impose on the country club set, even those who do nothing more productive or job creating than occasionally tip their caddy? Good point, but then why is it much better to make society’s most vulnerable jump those same hurdles because they dared to seek medical treatment?

For those who missed it — and given what a big week it’s been for abusing the country’s most vulnerable, from Salvadorans who have lived in the U.S. for more than a decade and now face deportation to hospital patients kicked to the curb in Baltimore, not to mention hearing how a president describes Haiti and African countries in the most vulgar of terms, that’s understandable — but the Woodlawn-based Centers for Medicare and Medicaid Services released guidelines that open the door to allowing states to impose work requirements on Medicaid recipients. That’s never happened before in the program’s 52-year history, but a bunch of red states — at least 10 at last count — want to deny health care to adults who don’t have a job or at least prove their disability prevents them from holding one.

What’s shocking about this is not that the Trump administration would fall in line with the misbegotten viewpoint that equates decent health care with welfare payments, it’s that the experts at CMS would go along with this charade. Studies show most Medicaid-eligible families already have at least one person holding down a job, it just doesn’t pay well enough to afford private health insurance, and thanks to recent tinkering with the Affordable Care Act, it’s not getting any more affordable anytime soon.

Is getting your high blood pressure treated or cancer detected really a disincentive to work? Even if you buy that argument, the fact that most Medicaid recipients are either working or disabled or “medically frail” shows there’s just not much juice to squeeze from this particular lemon anyway. Instead, how much more costly will Medicaid be if counselors or social workers or whoever is hired to track down the work status — or the alternative community service status or enrollment in school or job training — of the millions of adults who are eligible for the program? Here’s a quick diagnosis for this state of affairs: it’s crazy. A Kaiser Family Foundation analysis last year found that most of the 10 million Medicaid enrolled adults had legitimate excuses for not working with only 6 percent unemployed because they could not find a job.

Why can’t the U.S. provide both a cost-effective safety net for health care and opportunities for people to find meaningful work? What’s the point in denying health care other than cruelty or population reduction?

If the idiocy of this wasn’t clear enough, we would point to Congress’ failure to renew the Children’s Health Insurance Program that expired last fall. Again, it’s not the cost of the program that matters — the nonpartisan Congressional Budget Office has estimated that a 10-year CHIP extension would actually save the government $6 billion — it appears to be this desire to inflict greater pain on people living in poverty, in this case, millions of children. What’s the problem? The primary schoolers aren’t motivated enough to find well-paying careers on Wall Street or inherit millions? Fifty-four years ago, President Lyndon B. Johnson declared a war on poverty. Under the Trump administration, it’s evolved into a war against the poor.

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