In many ways, America gets more liberal all the time. While you can see it vividly on issues such as marriage equality where rapid change is obvious to just about everyone, it can also come up in surprising ways. That’s what Republicans confronted in 2017 when they tried to repeal the Affordable Care Act and discovered to their chagrin that Medicaid is a hugely popular program. Everyone knew seniors love their Medicare, but they figured that drastic cuts to Medicaid would be much less likely to spur a backlash, particularly since its recipients are low-income Americans with little power.

That was a miscalculation. Americans, it turns out, think very highly of Medicaid and were extremely resistant to the Republicans’ idea of kicking millions of people off the program.

They haven’t stopped trying, but in the absence of a repeal of the ACA, they’re pursuing an alternate tack to undermining Medicaid, one that has the added benefit of making the lives of poor people more stressful even if they manage to stay on the program. And it’s part of a broad Republican effort at both the national and state levels, one that amounts to a veritable war on poor Americans.

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To see what that war produces, I refer you to an absolutely brutal account by Amy Goldstein of a program Arkansas has instituted with the blessing of the Trump administration to impose work requirements on Medicaid recipients.

Work requirements sound good to many people on first glance — after all, shouldn’t people work if they’re able? — but in practice, they amount to the creation of a bureaucratic maze that recipients have to navigate, with the slightest misstep threatening to cost you your health coverage.

Here’s an illustration of how it’s working out:

Elizabeth Cloinger, 47, who lives in a trailer next to her cousin’s house just outside town, thought she was complying with the new rules. She has been on Medicaid for years and already had a job, working seven days most weeks as a home health aide. Her wages — 9.25 an hour, with 50 cents more for hospice patients — and her hours met the new rules. Yet she received a June letter saying she needed to verify that her income made her eligible, or she would be cut off.
She called the listed phone number and faxed information to a state employee in Pine Bluff. She was told that, like many people, she was exempt from the work requirements — in her case, because she was caring for her 20-year-old daughter recovering from a car accident and her 3-year-old granddaughter.
But on Aug. 18, she received another letter, saying she had been terminated because she had not verified her income. In December, four letters arrived saying she needed to update her email address, then 11 more in January. Each letter told her to create an online account. She doesn’t have a computer and didn’t realize that the program requires everyone to get an email address.

This woman is one of 18,000 Arkansans who have lost their health coverage because of the work requirements, even though she’s working and did her best to comply. But now she can’t go to the doctor for swelling in her foot. “I am just putting it in God’s hands,” she says. “He is going to let me stay on this Earth to see my grandbaby be raised.”

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When you read that story, what's your response? If it's "That's exactly what should happen to more people," then I've got some good news for you: The Republican Party is working hard to make your vision a reality.

Last year, the administration sent a letter to every state Medicaid director, urging them to enact work requirements so they could do the same thing to their own poor citizens that Arkansas has done to theirs. Kentucky’s work requirements have been held up by a lawsuit, Indiana’s are getting started, and programs in Wisconsin, New Hampshire, Michigan and Arizona are on their way. Other Republican-run states can’t wait to join.

The likely result will be hundreds of thousands of the most vulnerable Americans losing health coverage. And the president signed an executive order instructing agencies to create as many work requirements as possible to impose on low-income Americans who use food stamps, housing subsidies and other kinds of assistance.

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We have to say a word about the philosophy that drives these kind of steps. On one level, if we're talking about health care, it gets to whether you think it should be something everyone gets without questions asked — like an education through high school — or whether it's something that should be a function of how much money you have, not just what kind you get but whether you're allowed even a basic version.

Conservatives plainly see it as the latter. But more to the point, if it’s politically impossible to just take all government health care away from people, they’ll do what they can to make sure it comes with a dose of suffering and shame. You’ll have to navigate a bureaucratic maze to prove you’re worthy of the benefit, with the possibility of losing it always there — which adds stress and anxiety to people whose lives are already saturated with both.

And some would even like to impose drug testing on recipients, not because there’s some kind of drug problem among people on Medicaid but just to say that if we’re going to give you the privilege of health coverage, you’ll have to endure some humiliation along with it, just so it’s clear what society thinks of you.

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You may say that's a harsh caricature of conservative beliefs. But I'd encourage you to see it through a broader lens. One way to do that would be to tune into Fox Business any day, where you'll hear panegyrics to the noble "job creators," those who amassed their billions through nothing but hard work and pure hearts. If you truly believe that wealth is a sign of virtue — and conservatives certainly seem to — then the flip side is that those who don't have any must be morally unworthy, their station in life the product of only their own sins and sloth.

So of course when government deals with those people, it should shower them with the contempt they deserve. That’s what drives these policies: If they can’t destroy the safety net, Republicans will add as much misery to it as they can muster.

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