Corrections and clarifications: An earlier version of this column overstated the farm subsidies received by former Rep. Stephen Fincher.
Meet some of the people who benefited from the Obamacare expansion of Medicaid: A bedridden woman with a severe hernia who had the surgery she needed and went back to work. A person now getting treatment for bronchitis and asthma so “I'm able to be healthier and be more functional at work and able not to miss work.” People who said “I had a lot of health problems before. … Now I am able to work more.” And “I am finally getting everything that was wrong with me fixed so that I can go back to work.”
They are all quoted in a 2014 study by the Ohio Department of Medicaid, and their comments are on my mind as the Trump administration encourages states to impose work requirements on people who use Medicaid.
The administration and conservatives in general are very interested in making certain people (those without much money) prove they are worthy of receiving certain federal benefits (such as food stamps and Medicaid). The Heritage Foundation articulated it this way: Americans who receive these kinds of government benefits should “engage in responsible and constructive behavior as a condition of receiving aid.” That is, they should work or be looking for work, and they should be drug-free.
If only the worthiness test could be paired with a hypocrisy test, and both applied to beneficiaries of government generosity across the board. Take for instance former congressman Stephen Fincher, R-Tenn., who crusaded for $20 billion in food stamp cuts (“this is other people’s money,” and Washington shouldn’t “steal money” from some people to give to others). He accepted $3.6 million in federal farm subsidies from 1999 to 2016 (“other people’s money”). Now he’s running for the Senate.
There is no end to this kind of thing. There have been “actively engaged” farmers who got government money even though they didn’t actually, well, farm. The system gets gamed, one negotiator on the 2014 farm bill told me — your siblings can become partners and get subsidies, even if they're teachers and accountants.
How about the fat government contracts that enrich the private sector? The Obama administration tried to make sure the contracts — and taxpayer money — went to companies that complied with federal labor laws and standards. But President Trump and the GOP Congress got rid of that requirement.
Where are the drug tests for farmers, the good-citizen tests for corporations, the work requirements for rich beneficiaries of tax breaks and loopholes that drain massive amounts from the U.S. Treasury? Where is the requirement that companies and business owners, flush from their new tax cuts, use that money to raise pay and create jobs?
Ohio added 702,000 residents to Medicaid under the Obamacare expansion to people making 138% of the federal poverty level — up to about $16,600 a year, or $34,000 for a family of four. In telephone interviews with 5,111 of them in the Ohio study, three-quarters of those unemployed said the program made it easier to look for work. More than half with jobs said Medicaid coverage made it easier to continue working.
You might expect this group, with slightly higher incomes than those in the program before it expanded, to be more involved in the workforce. But statistics for the overall Medicaid program also belie the assumption that people who use it are lazy. Most are kids, seniors or disabled. Of the rest, more than 60% of working-age adults are working full- or part-time, according to the Kaiser Family Foundation. Nearly eight in 10 live in a household with someone who works. Those who aren’t working say they are retired, going to school, taking care of home or family, or physically unable to work.
No doubt there are malingerers and cheaters on Medicaid, just like there are people and companies that “game the system” to get tax breaks, subsidies or government contracts. But I don’t want my country to make medical care contingent on some politician’s view of what constitutes a deserving person.
Kentucky Gov. Matt Bevin is first out of the gate with federal permission to make people experience the “dignity” of work or risk getting locked out of Medicaid coverage for six months. He’s threatening to cancel the whole Medicaid expansion in his state (nearly 500,000 people!) if a court strikes down any part of his plan. Even if he’s bluffing, that’s quite an indication of where his heart is, or would be if he had one.
On the other hand, the Bevin approach is one way to solve the “Obamacare dependency crisis,” as the Foundation for Government Accountability calls it in a new report. The gist: Those able-bodied, working-age adults are flocking to Medicaid, and it’s got to be stopped before states go bankrupt.
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The fact is, we have an irrational, inefficient health care system that relies largely on employers to provide insurance coverage. Many of them don’t. And for all kinds of reasons, not everyone has a job. We are a rich nation. If we prioritized the health and financial stability of our fellow Americans, we could make it possible for everyone to have insurance — even the miscreants who might not deserve it.
Instead we’re going in the opposite direction, with coverage shrinking as Trump and congressional conservatives wreak havoc on the flawed, best hope we had to live up to our most compassionate selves and, from a workforce standpoint, our most practical. It will shrink further as new paperwork does its job of discouraging people from continuing or signing up.
Proof you're working. Proof you can’t work. Proof of income. Proof you’ve paid your share. Proof you are a worthy person.
If we’re going to test character, we should start with the Trumps and Bevins of the world.