May 25, 2022

Trump just greenlit New Hampshire Republicans’ latest sneak attack on healthcare

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New Hampshire has become the fourth state dominated by Republicans to get approval to impose work requirements on Medicaid recipients under a waiver from a federal government agency run by Trump and the Republicans after they failed in repeated efforts to kill the program created under the Affordable Care Act. 

The imposition of work requirements is what New York Magazine calls “the shiny new toy for Republican lawmakers” who claim their purpose is to “empower” the current recipients “with the dignity of work” and “control the cost of Medicaid.”

This will “help people gain the skills necessary for long-term independence and success,” New Hampshire’s Republican Gov. Chris Sununu said in a statement.

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Critics argue however that even with exceptions for senior citizens, pregnant women and women with children, many of those adults aged 19 to 64 currently receiving benefits will be hard pressed to meet New Hampshire’s requirement of at least 100 hours of work a month or participating in job training or community service. 

“A mandatory work rule is such a silly waste of resources [considering] how few people are actually sitting around not working,”  Sara Rosenbaum,a professor of health law and policy with the Milken Institute School of Public Health at the George Washington University, who told U.S. News she deplores the “thoughtlessness” of the idea.

“You can only understand it as a way to drive people off the program.,” said Rosenbaum.

She said most people who can work already do so and predicted that older people – those from around 50 up to 64 – will find it difficult to meet the new work requirements.

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“People who just don’t have skills,” she said, “who got laid off; who did hard, intensive labor all their lives and now they just can’t do it anymore, or they can do a very limited amount.”

There are also major issues around the ability of people to do the necessary paperwork to comply with the program, and the unfunded costs to the states and counties which will run into the millions – money that will likely be taken from other existing programs – like food stamps or non-emergency medical transport – instead of being spent on those who need it.

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Tennessee, one of the other states with an approved waiver, is now debating whether to take the money to administer the program from the Temporary Assistance for Needy Families program, which provides federal funding under the welfare program.

In Ohio, a think tank, the Center for Community Solutions, estimates county departments of job and family services would to spend more than $378 million over the next five years, with  Cuyahoga County paying more than $10.8 million of that, according to Modern Healthcare magazine.

Modern Healthcare also reported that almost every hospital and medical facility they contact was against the imposition of the work requirements because they believe it will be an administrative nightmare, hurt patients and in the end cost them more money.

“It is our belief, and that of our member hospitals, that…these changes to Ohio’s Medicaid program will result in waves of dis-enrollment, greater administrative costs and a disruption of care at the provider level,” Philip Mazanec, interim president and CEO of the Center for Health Affairs, wrote in the organization’s comments to the state.

In a letter to the state of Ohio, the Center for Health Affairs noted the waiver will, according to Modern Healthcare, “negatively affect the health care delivery system by disrupting the continuity of care and, as a result of lost coverage, force patients back to relying on the emergency department for primary care needs — a much costlier route.

Even reaching recipients will be a problem. Many do not have computer skills or a broadband connection, and some are homeless and may be nearly impossible to contact regularly.

There is also a problem in that many of the working poor, who do jobs like restaurant work or construction or retail, work seasonally so they will not meet the monthly quota of hours that must be worked, according to Roll Call, forcing them off Medicaid.

“In other words: A Medicaid work requirement could force working people to lose their health insurance because” added Roll Call, “it isn’t structured to reflect the realities of what work looks like for people with lower incomes.”

There are also issues around who can work and who judges if they can work. For instance, if a person has a history of medical problems and is frail, they may not be able to do a lot of jobs that require labor or physical endurance.

None of that is made clear by the federal government, and it is sketchy even in the various kind of state rules being mandated, which vary wildly from state to state.

In Michigan, for instance, there are accusations of racism after the state legislature included an exemption for countries that have more than 8.5 percent unemployment from the work rules.

The effect is that in mostly-white northern rural counties where there is high unemployment, the work rules do not apply.

However, in Detroit, where the population is mostly African-American it will apply even though the city’s unemployment rate is above 8.5 percent. That is because the country in which Detroit exists has an overall unemployment rate under six percent because it includes many high-income suburbs.

Detroit Free Press Columnist Nancy Kaffer, according to New York Magazine, explained that “Detroiters living in poverty, with a dysfunctional transit system that makes it harder to reach good-paying jobs, won’t qualify for that exemption. The same is true in Flint and the state’s other struggling cities.”

Even without the preferential treatment toward rural residents,” writes New York Magazine, “the work requirement is a cruel and potentially useless policy.”

“Though proponents argue that work requirements will spur Medicaid recipients to become self-sufficient and find work, most Medicaid recipients in Michigan are either already working or unable to work. “

A study in Michigan found only a quarter of residents are considered out of work but able to hold a job. Of that group, two-thirds have mental or physical disabilities.

“Under the new rules,” added New York Magazine, “they would be required to prove that they qualify for an exemption, a process that is made intentionally difficult and results in fewer people on the Medicaid roles.”

Which brings us back to where we started – this is not about work bringing dignity to people. It is about getting people off the Medicaid rolls because many of these Republicans do not want anyone to get government assistance, no matter how cruel that may be to the person.

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This is Trump’s philosophy put into action, in a way that not only effectively removes part of the safety net that America has been created since the days of FDR and LBJ but also satisfies rich taxpayers (who are big political donors) like the Koch brothers who don’t want a lot of these needy people to be getting assistance. 

There are another half dozen Republican-dominated states still waiting to get waivers, and each will write their own quirky version of the rules to disenroll as many as possible.

Even if Trump was to be forced out tomorrow, his legacy of nasty government, business over people, and cutting taxes on the rich at the expense of the poor will continue for years to come.

Benjamin Locke

Benjamin Locke is a retired college professor with an undergraduate degree in Industrial Labor and Relations from Cornell University and an MBA from the European School of Management.

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