In a story posted on talkpoverty.org, Kristen Arant described how she contemplated suicide because she had no health insurance to help her cope with her opioid addiction. Finally getting Medicaid, she said, literally saved her life. Now she is worried that the federal government’s new rules allowing states to impose work requirements to get Medicaid will strip her of her coverage.
Healthcare is a top issue in the country. Rarely mentioned though, is the dangerous thread that continues to unravel our profoundly deteriorating healthcare system: the unrelenting assault on Medicaid. For the first time since Medicaid’s passage in 1965, waivers—which allow states to do things they couldn’t otherwise do, such as make people work for their Medicaid—are being used to restrict, rather than extend Medicaid coverage. The goal is to force people off of Medicaid. Worth noting: 60% of adults on Medicaid already work.
This approach to cutting back Medicaid dredges up false divisions in the working class between the “deserving” and the “undeserving” poor, in a country where 75 million people rely on Medicaid for their health insurance. These “Section 1115” waivers are aimed mainly at around 25 million working class adults whose states expanded Medicaid as part of the ACA legislation.
As of the end of April, three states have been given federal permission to impose work requirements and other Medicaid restrictions, and seven others have applications pending for such requirements. In Kentucky, where the restrictions have been approved, it’s estimated that about 95,000 enrollees will be forced off the program.
Besides work requirements, the Section 1115 waivers can permit such things as drug screening, imposing premiums and eligibility time limits, and dropping people from Medicaid for non-payment of premiums and other “violations.” The restrictions smack of control and criminalization of the poorest in our country. And the money saved will be used to pay for the $1.5 trillion tax cut Congress recently awarded to the richest Americans.
The uninsured population in states that did not expand Medicaid has risen 22%. The four southern states of Texas, Georgia, Florida and North Carolina are home to 89% of those falling in the “Medicaid Gap,” but that’s not stopping North Carolina and Texas from applying for punishing waivers. Mississippi, another non-expansion state, is proposing a work requirement that targets parents and caregivers who make less than $3,250 a year!
Michigan’s proposed work requirement is tied to the unemployment rate in each county. It’s likely to lead to rural, whiter counties, where unemployment is higher, getting a break from the work requirements, while urban areas with a higher share of Black residents and lower unemployment rates would still be subjected to them. This is a divisive tactic similar to the one used to impose federal cuts in welfare in the past, or to impose the dictatorial emergency manager system on some Michigan cities—the Black workers are painted as lazy and incompetent, and therefore needing to be “disciplined” with cutbacks. This sets the stage for the cuts to be applied to everyone.
The assault on Medicaid—which is a death sentence for some—is being challenged by a growing awareness that Single Payer, Improved and Expanded Medicare for All is necessary to end the charade of health insecurity in a country of abundance. The electoral arena is one part of this battlefield. A unified, bottom-up strategy that defends the needs of those most at risk—the uninsured, the undocumented and those on Medicaid—is necessary to go on the offensive for government-guaranteed, equal and comprehensive healthcare for all. If a corporate government acts to deny necessary healthcare, then a bold, visionary social movement must act to confront government, conscious that only a public not private system of care can assure that Everybody Is In and Nobody is Out!