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Trump opens the door to needlessly cruel Medicaid changes

Voters who believed Donald Trump's vows to protect Medicaid are going to be disappointed.
A stethoscope sits on an examination table in an exam room at a Community Clinic Inc. health center in Takoma Park, Maryland, April 8, 2015. (Photo by Andrew Harrer/Bloomberg/Getty)
A stethoscope sits on an examination table in an exam room at a Community Clinic Inc. health center in Takoma Park, Maryland, April 8, 2015. 

It's easy to forget, but as a presidential candidate, Donald Trump broke with Republican orthodoxy and promised to champion the social-insurance programs the American mainstream has come to rely on. Indeed, in his campaign kick-off speech, Trump said he'd make no cuts to Medicaid, Medicare, or Social Security -- a vow he repeated on Twitter over and over and over again.

As president, the Republican abandoned the commitment rather quickly, endorsing regressive GOP plans that included brutal cuts to Medicaid. As 2018 gets under way, Trump is taking yet another regressive step on the same issue.

On Thursday, the Centers for Medicaid & Medicare Services (CMS) released a letter inviting states to impose work and community service requirements on their Medicaid populations and describing what types of restrictions would be acceptable. States would first have to seek a Section 1115 waiver, a provision that allows the administration to approve experimental plans. The Obama administration rejected prior waiver requests from states to add work requirements. [...]Opponents of the decision have argued that work requirements go beyond Medicaid's stated goal to provide aid to low-income households and that only Congress can expand its objectives to also include pushing people toward employment. This is likely to be a primary contention in lawsuits challenging the administration.

There's reason to believe opponents of the Trump administration's policy will have some success in challenging yesterday's announcement, but even putting legal questions aside, it's important to recognize just how misguided the White House's new policy really is.

Vox had a good piece on this yesterday, taking a closer look at the program's beneficiaries.

The majority of people benefiting from Medicaid are children, disabled, or elderly, and would be exempt from work requirements. If you exclude pregnant women and parents with young children, the number of affected people shrinks even more. The majority of the remaining non-disabled adults are working. And some of them can only work because they get Medicaid — such as people who have mental illnesses or struggle with substance abuse but who, with reliable health care, are healthy and stable enough to work. Making work a prerequisite for Medicaid could, perversely, wind up preventing such people from working."It would really harm people least able to hold and keep a job and hurt people who need health care to participate in the workforce," Hannah Katch, a senior policy analyst at the Center on Budget and Policy Priorities and a former official in California's Medicaid program, says.

Sara Rosenbaum, a professor of health policy at George Washington University who serves on a board advising Congress on Medicaid policy, told Vox, "This is a solution in search of a problem. There's just no evidence that too many people aren't working who can work. If you say 'able-bodied' enough times, you give a sense that there are people just sitting around who could work, but that's just not the case."

Indeed, it doesn't really make sense. New York's Jon Chait added, "You might know, or at least can imagine, somebody who would choose to stay home all day playing video games and collecting cash payments from the government. But is anybody going to stay home all day because of ... free visits to the doctor?"

Of course, just because Trump World has opened the door to states imposing work requirements on Medicaid beneficiaries doesn't mean governors and state policymakers will take advantage of the opportunity. That said, 10 states have sought permission to make these changes -- Trump won eight of them, suggesting he's likely to hurt some of his own supporters -- and Kentucky Gov. Matt Bevin (R) just received the green light from the Trump administration to move forward with his plans.

No good will come of this.