Once in office, President Trump has fully embraced policies that rest firmly on that same economic orthodoxy — policies that are ostensibly designed to help economically struggling Americans with tax cuts for job creators and liberation from dependence on the safety net.
Here’s the latest example of this: The Trump administration has just announced that it will allow states to impose work and other requirements on recipients of Medicaid. This is a big change. After the failure to repeal the Affordable Care Act, this is meant to begin rewriting the social contract at the core of government-sponsored medical insurance, and especially the ACA’s Medicaid expansion, shifting away from the notion that health coverage should be available to those who cannot afford it as a matter of societal right. As such, it may have a negative impact on untold numbers of Trump voters.
The core ideological idea behind the change is that Medicaid can be improved by using it to incentivize (i.e., require) able-bodied adults to work, or seek job training or education, or enter into other forms of “community engagement” to collect benefits. The federal government will now allow states to “test” such policies to improve the “well-being” or foster the “independence” of Medicaid enrollees. The Obama administration had refused to grant such requests by states, on the grounds that such requirements don’t “further the objectives” of Medicaid. The Trump administration thinks these requirements will further those objectives.
In the background of this argument is a deeper dispute. Some conservatives have attacked the ACA’s Medicaid expansion because it extends Medicaid coverage to many more poor “able-bodied adults,” which they oppose either because this risks trapping them in dependency or because they think redistributing to those who can support themselves is inherently wrong. But liberals argue not just that basic medical coverage funded by taxation should be available as a right, including to people who are able to work and/or do work but cannot afford coverage, but also that it is liberating to poor people and makes it easier for them to work.
Buttressing the liberal argument, a recent Kaiser Family Foundation analysis found that of the nearly 25 million non-elderly Medicaid recipients, a majority are already working, meaning they qualify for Medicaid (and thus can’t afford insurance) even though they are employed, which allows them to work these jobs and still get coverage. Meanwhile, of those who are not employed, most report serious health and other impediments to working, meaning the obstacle isn’t dependency or a lack of motivation.
Such requirements are likely to be imposed in states carried by Trump. The Post reports that 10 states are already trying to get permission to impose them, almost all of them red states. This, among other things, leads Harold Pollack, a health-policy expert at the University of Chicago, to conclude that “Medicaid work requirements may hit Trump country hardest.”
“They could hit underemployed early-retirees who now find themselves reliant on Medicaid,” Pollack told me today. “They could hit surprising numbers of people with disabilities — including addiction to opioids — who are covered under the ACA Medicaid expansion but can’t fill the requirements. They could hit hospitals in low-income rural areas that provide services to people who have lost Medicaid and can’t pay.”
Beyond the substantive debate over work requirements, this is not the story Trump told during the campaign. He sent a strong message that he was not a Paul Ryanist Republican on economic matters. He vowed to go after Wall Streeters who had engorged themselves off the rigged the economy. He vowed to protect the safety net, generally holding up the Orthodox Ryanist vision of it (which treats it as a “hammock” of “dependency”) as a foil. But now Trump has signed a tax bill that lavishes enormous benefits on financial elites and further rigs the tax code in ways they’re well-positioned to exploit. He has gone all in with Orthodox Ryanism on the safety net, moving to roll back health-care coverage for millions (but failing). Now his administration is shaping policy around the Ryanist idea that the safety net is a dependency trap.
But, as Pollack points out to me, this demonstrates again that elections have consequences. The Trump administration is simply acquiescing to the demands of many Republican legislators across the country who are where they are because Democrats lost so much ground on the state level during the Obama years. “If we liberals don’t like work requirements, we need to get out there and actually win more elections,” Pollack says. Including in Trump country, as today’s announcement underscores.
* DEMOCRATS GROW MORE AGGRESSIVE ON GOP AND RUSSIA: The Post reports that Democratic leaders are increasingly convinced that Republicans are only interested in helping to shield Trump from accountability, and are reacting accordingly:
Democrats across Congress charge that the GOP has long since abandoned its commitment to investigate allegations against the president. They say Republicans’ focus on the dossier, their continued scrutiny of the FBI’s conduct during the Hillary Clinton email probe, their revived interest in how the Justice Department explored the circumstances of a 2010 uranium deal, and recent calls for special counsel Robert S. Mueller III to step down over alleged bias in his team’s ranks all are attempts to block for Trump.
Dems are hardening their tactics: They put out the Fusion GPS transcript and a report on Trump’s failure to protect our elections, and may do a House intel minority report on GOP efforts to frustrate fact-finding.
* REPUBLICANS MAY BE STYMIED IN 2018: Politico reports that Senate Republicans are privately considering not passing a budget this year, which would deny them the use of “reconciliation” to pass things by simple majority without Democrats:
That means no entitlement reform or welfare overhaul in 2018, a key priority for fiscal conservatives eager to shrink the now $20 trillion federal debt. … It’s the latest sign of the decline of the party’s fiscal conservatives under Trump, who has shown little interest in cutting government spending and has begun to mold the party into his own image.
After failing to repeal most of Obamacare, now Republicans may be thwarted in their other efforts to “reform” (i.e., shred) the safety net. Sad!
* FEARFUL ‘DREAMERS’ ARE IN LIMBO: The New York Times talks to a number of “dreamers” and dramatizes the fear and uncertainty that hundreds of thousands are feeling as Washington decides their fates:
Perhaps more than any other single group of people in the country, the Dreamers … have had their lives shaped directly by the mood swings of national politics. … While Congress engages in a high-stakes staring contest over a substitute program, immigrants have already begun losing their protections, exposing them to deportation.
As one 20-year-old dreamer put it, “I had all these plans,” but “now I feel like I don’t have control over my own future anymore.”
* TRUMP IS STILL RAGING AT SESSIONS: The Post’s Matt Zapotsky and Josh Dawsey report that Attorney General Jeff Sessions is working to get back into Trump’s good graces by pushing some of his ugliest policies. But it just ain’t working:
Sessions … has, by all accounts, been unable to repair his relationship with the president. Trump has dismissed praise of Sessions, according to four White House officials and advisers, as he continues to rage about the Russia investigation and Sessions’s decision to recuse himself from the probe.
That really is unfortunate. Sessions failed to fully enable Trump’s authoritarianism and turn law enforcement into his loyal protector. Trump will never get past that.
* THE PROBLEM IS THE FAR RIGHT: In a momentary lapse, Trump said he’d favor a clean solution for the dreamers, then backtracked. E.J. Dionne Jr. points out that this, plus the battle over the Children’s Health Insurance Program (CHIP), shows that the real obstacle on both is far-right Republicans:
Progress in many areas where the parties could work together is being blocked because of the need for Trump and the Republican Party to kowtow to conservative ultras. In his unguarded moment, Trump simply reflected the belief of the vast majority of Americans that it is ridiculous and cruel to deport the dreamers. … The Children’s Health Insurance Program … gets health care to 9 million young Americans. But the renewal is hung up because House Republicans are demanding that it be paid for by cutting Obamacare spending.
This is exacerbated by the fact that Trump doesn’t care about policy or its impact on millions, so he doesn’t meaningfully advocate for anything.
* TRUMP SPINS FANTASY ABOUT FBI AND CLINTON: Trump is now saying he won’t commit to an interview with special counsel Robert S. Mueller III, citing … Hillary Clinton as the reason why. As the New York Times summarizes it, Trump is once again torturing the truth:
“She wasn’t sworn in; she wasn’t given the oath; they didn’t take notes; they didn’t record,” Mr. Trump said. “That is perhaps ridiculous, and a lot of people looked upon that as being a very serious breach — and it really was.” Mrs. Clinton’s interview was a standard one for the F.B.I., which typically does not place people under oath because lying to the agency is a crime, and it rarely records voluntary interviews.
If there is one thing that might goad Trump into trying to remove Mueller, it’s the fantasy that the FBI was soft on Clinton, even as he is being investigated “unfairly.”
* AND TRUMP TRIES TO TAKE CREDIT FOR ECONOMY, DOES PRATFALL: Good morning, Mr. President:
That’s wonderful! Except the same Quinnipiac poll finds that only 37 percent say Trump’s policies are helping the economy vs. 59 percent who don’t believe that, even as voters say that President Barack Obama is responsible for the current economy by 49-40 percent.