Politics, Moderate



Trump is hoping you won't notice his backdoor repeal of Obamacare

Catherine Rampell on

In the half-century since Medicaid was first created, eligibility has always been based almost entirely on financial circumstances such as income and assets; the program's goal, after all, was to help less-well-off Americans obtain medical care. Last week, though, the Trump administration announced that it would start allowing states to impose other requirements on Medicaid recipients, including proof that they are working, looking for work, volunteering or in school.

"I was raised with a mind-set to work, give an honest day's work for an honest day's pay," Kentucky Gov. Matt Bevin (R) said at a news conference announcing that his state was the first to receive a waiver allowing Medicaid work requirements. "It's the very same thinking that we want to bring to people here in Kentucky that are able to participate."

But there's no reason to think, in Kentucky or other states itching to add work requirements, that there are legions of Medicaid loafers. Nearly 8 in 10 Medicaid-enrolled nonelderly adults already live in working families, and most (60 percent) are working themselves, according to the Kaiser Family Foundation. Most who are not working report major impediments to their ability to get a job, such as illness, disability, school enrollment or caregiving responsibilities.

But that won't necessarily protect eligible low-income people from being kicked off Medicaid rolls anyway.

Verifying that beneficiaries meet work requirements will impose a huge and costly new administrative burden on states, and also on the working poor. As the Trump administration letter approving Kentucky's work requirements acknowledged, the state's Medicaid phone lines are already overwhelmed. If working Kentuckians are unable to cut through the red tape, they can get locked out of the system for six months.

The Trump administration argues, somewhat confusingly, that the new work requirements will actually improve public health. Why? Because they'll encourage more poor people to find jobs, and employed people tend to have fewer health problems.

This likely gets the causality backward, though, given how many Americans report illness as a barrier to getting or keeping a job.

Focus groups and state-level studies have found that Obamacare's Medicaid expansion helped lower-income people gain work or remain employed; inversely, reducing long-term access to physical, mental and substance-abuse treatment is likely to hurt both health and employment prospects.


If the Trump administration truly wants to help more Americans find jobs -- a goal that both parties can surely get behind -- there are far more effective tools than taking away health care. Investing in skills, apprenticeships and job-matching services, for instance. Or expanding the earned-income tax credit, a historically bipartisan program curiously absent from the recent tax bill.

Instead, they're still fixated on dismantling Obamacare, through this backdoor regulatory repeal.

Republicans are counting on the notion that a raft of wonkish-sounding waivers -- unlike last year's splashy, failed Trumpcare legislation -- will inspire no riots in the streets, no rowdy town halls, no phone-line-jamming and no mass mobilization to protect health care for the nation's most vulnerable.

Who wants to prove them wrong?


Catherine Rampell's email address is crampell@washpost.com. Follow her on Twitter, @crampell.

(c) 2018, Washington Post Writers Group

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