The Washington PostDemocracy Dies in Darkness

Opinion The GOP’s cruelty toward the poor is paying dividends in suffering

(Reuters/Karen Pulfer Focht)

The most significant part of the Affordable Care Act, itself the most significant piece of social legislation passed in decades, was its expansion of Medicaid. The idea was that no one should go without health insurance because they can’t afford it, so the program was expanded to cover millions of Americans who, though extremely poor, weren’t eligible under the often restrictive rules set by states.

But the fact that so many people now get insurance from the government stuck in Republicans’ craws. They quite literally would rather see someone go without health coverage than see them get that coverage from the government, and ever since it went into effect they’ve been trying to undo it.

You think that’s unfair? Pose that choice to a Republican official — Is it better for someone to get health coverage from the government than to go without coverage at all? — and see what they say. Or you don’t even have to do that. You just have to watch what they’re doing.

Having failed to repeal the ACA, the administration and Republicans at the state level have turned to a different tool in order to kick people off Medicaid: work requirements. This horrific news from Arkansas shows they’re working exactly as Republicans intend:

Several thousand poor residents of Arkansas have been dropped from Medicaid because they failed to meet new requirements, the first Americans to lose the safety-net health insurance under rules compelling recipients to work or prepare for a job to keep their coverage.
Gov. Asa Hutchinson (R) announced Wednesday that 4,353 people have become ineligible for Medicaid, out of an initial group of nearly 26,000 who became subject to the requirements this spring.

While work requirements have a surface appeal (hey, shouldn’t people work if they can?), the truth is that in practice they do nothing to encourage work and only provide an excuse to take away people’s health coverage. First of all, no one says to themselves, “Well I could go get a job, but with this sweet health insurance, I can just sit at home and all my needs are met!”

Second, nearly everyone who is currently on Medicaid is either working or meets one of the criteria for an exemption, such as having a disability or caring for a sick loved one. According to this just-published research, the number of people who are eligible for Medicaid and could be working but aren’t is minuscule. In Arkansas, it was 0.8 percent. In other words, the Arkansas work requirement is meant to ferret out the fewer than one in a hundred people who are getting the insurance and could go get a job — and yet they’re kicking off one in six people who become subject to the requirement.

That’s because in order to find that one in a hundred people, the state makes the other 99 jump through a whole series of bureaucratic hoops in order to prove that they’re working, and working enough hours. And if you can’t navigate that process without making mistakes, you get your insurance taken away:

The concrete reality of more than 4,300 individuals losing insurance — diminishing their access to care — is alarming leaders at medical and mental health clinics and hospitals, as well as legal advocates for the poor. They say logistics of the work rules are ill-suited to the lives of many poor Arkansans, who may not have computer access to report their hours online or may not have even received — or understood — letters the state sent telling them how to stay on Medicaid.
Statewide, nearly a fourth of the population lives in areas in which Internet service is not available, according to figures from the Federal Communications Commission. Even when they have cellphones, many low-income people have plans in which they pay by the minute, said LaShannon Spencer, chief executive of the Community Health Centers of Arkansas. “So spending your minutes to report [work hours] — what’s the likelihood?” Spencer asked.
In Lee County in the Mississippi Delta, where poverty is rampant, nearly three-quarters of the people lack online access. “I’ve had people say, ‘What’s Arkansas Works?’ and I’m thinking, ‘Oh my gosh, you don’t even know what it is, so how do you know that you need to go online and report work?’ ” said Kellee Farris, who runs the Lee County Cooperative Clinic.

I can’t stress this enough: This is the whole point. It isn’t about helping people find work, and it’s not about promoting “personal responsibility.” It’s a philosophy that says that poor people are morally deficient and they must be punished and shamed. If they’re going to get assistance it’s going to come with conditions and requirements — in this case, a bureaucratic obstacle course they have to run through — and if they fail to satisfy them, then they get tossed off. The party that says it hates government bureaucracy uses bureaucracy as a weapon against the poor.

Conservative states have even proposed lifetime limits on Medicaid, so that if you get it for a few years, you’ll be barred from ever getting it again for the rest of your life. You may have noticed that nobody proposes lifetime limits on, say, the mortgage interest deduction, in which the government pays part of your mortgage for you. Because that’s a benefit that the rich and middle class enjoy. And you can now deduct the cost of your corporate jet, so that’s a relief.

But all this is just the beginning. Especially if Democrats take back one or both houses of Congress this fall, Republicans will know that their dream of repealing the ACA is dead for all time. In response, they’ll ramp up efforts to punish the poor, with Medicaid work requirements and who knows what else. More people will lose their coverage and more people will suffer. I’d ask whether the Republicans’ cruelty knows any limit, but I think we know the answer.