Poverty is not a scam. Neither is old age or infirmity or serious illness. But making poverty and the need for help look like a scam is a common political strategy, and it’s one President Donald Trump’s administration sought to rekindle last week when it allowed states to impose work requirements on Medicaid recipients in “test” programs.
Such a change, based on fiction about who the 70 million Medicaid recipients are and how almost $550 billion in state and federal Medicaid funding is spent each year, won’t save any taxpayer dollars. Nor is it intended to. What it does is spawn news stories that reinforce a message Republicans have promoted since President Ronald Reagan: The GOP brings down mostly minority “welfare queens” riding high on government largesse in their Cadillacs.
Census data from 2016 are more revealing. In Medicaid households that don’t include an elderly recipient, 64 percent had an adult who worked full time and 13 percent included an adult who worked part time. Part time is all the work the tests will require. The rest of recipients most often don’t work because they are disabled, or care full time for elderly relatives or children who are disabled.
Certainly there is some waste, fraud and abuse, as in any program, but the facts show most Medicaid recipients who can work do. Most cynical politicians know that. The great undiscussed expense is that 64 percent of Americans in nursing homes rely on Medicaid for their care. And many of those who accept public funds have gone to great lengths to shield their personal wealth.
The new job requirements for Medicaid might not be legal and likely will be challenged in court. Either way, the rules won’t save much even if they do take effect. Since only 70 million Americans get Medicaid and 255 million don’t, the proposals might not cause much uproar. But be warned: As a statement of intent and a first shot across the bow, they should.
House Speaker Paul Ryan and Senate Majority Leader Mitch McConnell have been clear about wanting huge across-the-board cuts in Medicaid and Medicare. The cuts have been included in budget proposals they have introduced, and in their efforts to repeal the Affordable Care Act. Ryan has said cuts to those programs, along with restructuring Social Security to save money, are his primary legislative objectives, although he concedes they probably won’t happen in 2018. That likely has to do with midterm elections coming up.
This week, Gov. Andrew M. Cuomo will deliver a budget expected to be as shot through with uncertainty as any New York has seen in decades, and that’s largely because of the federal government. The end to the Obamacare insurance mandate in the new tax law could lead to an exodus from the insurance rolls by young, healthy Americans, upsetting rates, coverage and expenses at public-mission hospitals that treat the uninsured. That law also triggers cuts in Medicaid and Medicare funding. And it creates a huge tax hike for New Yorkers, who will no longer be able to take full deductions for state and local taxes and mortgage interest.
It’s no good thinking the Medicaid work requirement doesn’t matter because it seems those allowing it aren’t coming for you. They are coming for you. They’ve said so. And they’ve begun.