Medicaid work requirements: Big Brother would be proud
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The dystopian society of George Orwell’s 1984 introduced us to “doublespeak” -- a language used to deliberately obscure, distort, or even invert the meaning of words in order to fit an agenda. With her op-ed entitled “Making Medicaid a Path Out of Poverty,” Seema Verma, the Director of the Centers for Medicare and Medicaid Services, has given us a master class in its practice. 
 
First, let’s tackle the obvious. With a title like that, you might think that Verma and the Trump administration are acknowledging how poor health and poverty can be intrinsically linked, with one often exacerbating the other. As someone who has spent years working to provide health care services to our most vulnerable populations, in the largest contiguous area of poverty in the United States, I am witness to the downstream health effects of social inequality and vice versa. Gaining access to low or no-cost care can, in fact, be a transformative first step on the path out of poverty. Instead, Verma is actually making arguments in favor of imposing work requirements for Medicaid benefits. Actually, Verma prebuts the inevitable cries of callousness by completely rebranding “work” as “community engagement” requirements.
 
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With this argument, this administration is resurrecting the seemingly immortal myth that Medicaid recipients don’t already work. In fact, 60 percent of Medicaid recipients are working themselves, while nearly eight in ten live in families where at least one member works. Of those not working, most report major impediments to their ability to work, including caregiving responsibilities. So, what would this actually do? Monitoring the work requirements will require resources and time, adding to higher costs and administrative burdens. It will increase the ranks of the uninsured, with folks who have no other options for affordable care. Those patients won’t suddenly stop getting sick, but without access to their primary care physician, they’ll ultimately wind up in the emergency room for avoidable -- and much more expensive-- health problems.
 
But this narrative doesn’t fit the Trump administration agenda. So they obfuscate, with Verma claiming that these “compassionate” work programs would “help [Medicaid recipients] achieve the dignity and self-sufficiency they deserve.” At St. John’s Well Child and Family Center, we believe that health care is a right, not a privilege. What these folks “deserve” is access to affordable care, free from a patronizing and paternalistic government. They deserve to see our country meaningfully address the economic and political structures that sustain the poverty and poor health cycle. 
 
Let’s just entertain Verma’s doublespeak: that employment improves your health, therefore adding work requirements to Medicaid is good for the recipient's health -- both physical and economic. It sounds reasonable, until you dig into the factsStudies of other low-income benefit programs show that work requirements have little or no effect in increasing work or cutting poverty. In fact, the majority of people remained poor or even became poorer. 
 
Because here’s the ultimate farce of this whole Orwellian tragedy: with the globalization of the world economy, many low-income Americans haven’t been trained to compete in today’s economy.  As the Trump administration passes tax laws to further exacerbate income inequality and penalize the poor; as they cut job training and social programs – our most vulnerable citizens – those who depend on Medicaid for their very lives, are left increasingly vulnerable. 
 
Many of us who have been engaged in providing health care services to the most vulnerable populations in the poorest areas of our nation for many years, reject Verma’s dystopian vision of public health care programs. We see it for exactly what it is: this administration’s attempt to further unravel the Affordable Care Act – in this case, the Medicaid expansion – which gave millions of low-income adults access to the program and primary care for the first time in their lives.  
 
Verma claims that what they’re actually doing is empowering “…states to work with their communities, providers and citizens to design innovative programs that meets their diverse needs.”  She conveniently leaves out, in true doublespeak fashion, that as the Affordable Care Act Medicaid Expansion continues, states will be required to pay for more and more of their share of the program. This is merely a way to allow the states to save money at the expense of poor Americans. By creating barriers for people to access health care, states will be incentivized to cut back on this vital safety net program.
 
“Black is white.”  Denying people health care will make them healthier. Cutting America’s most significant anti-poverty program -- Medicaid -- will give people a “pathway out of poverty.”  Big brother would be proud.
 
Mangia is CEO and president of St. John's Well Child and Family Center.