Friday, January 5, 2018

Bomb Cyclone For Healthcare

It's January, and it's cold and snowy outside, and therefore, the media tells us, the end of the world is nigh. Iguanas are literally falling out of trees! Wind chills are expected to plunge below zero for the next two whole days!

It's January, and Donald Trump is still president, and therefore the end of the world is nigh. The only new twist in this man-made disaster is that the people who surround him and enable him as he storms and fumes and tweets his way around the White House were willing to spill their guts for a new blockbuster book. They don't seem to realize how venal they themselves look by putting their careers and their fortunes above the good of the country as they gleefully call Boss Trump an idiot and a moron behind his back. The punditocracy is giving new life to the 25th amendment as a backup to the flailing RussiaGate investigation.

These are the bombshell blockbusters dominating the official discourse this week. These are the cyclones in the news cycle.

But conveniently lost in the swirling vortex are some malevolent plans to force the poorest of the poor to die more quickly than usual. People getting their healthcare through Medicaid will now be forced to work in some states, even though many of them already do work: whether be it toiling away at Walmart and McDonalds, or staying at home to care for children or sick or elderly family members.

What Bill Clinton accomplished by kicking millions of people off cash welfare in the 90s, the Trump administration hopes to finish off by ensuring that the vulnerable fall through the remaining tatters of the safety net. 

As a matter of fact, the supposedly demented Trump and his minions are using Clintonian welfare reform (Temporary Aid to Needy Families, or TANF) as their template for the destruction of Medicaid.

Seema Verma, the arch-conservative ideologue and Hewlett-Packard exec named by Trump to lead the Medicare and Medicaid Services division of HHS, is spewing the old canard that  "able-bodied" adults who get government-funded health care coverage are the victims of a form of bigotry. Unless they are forced to work until they drop, her twisted logic is, they will feel just like slaves, but without the sustaining self-sufficiency. "The days of low expectations are over," she vowed.

But, as a study by the Kaiser Family Foundation on the efficacy of TANF for incentivizing welfare recipients to go to work has proven, people don't work because they're forced to, they work because they want to and they have to in order to live. People are not, as a rule, inherently lazy. People are unemployed for the simple reasons that they can't find work, or because they become too sick to work, or they got laid off, or because they otherwise face insurmountable barriers to employment.

Forcing Medicaid recipients to work will not only not lift them out of poverty, it potentially will have the result of impoverishing them still further, when employee labor costs such as transportation and child and elder care are factored into the Trump administration's proposed draconian requirements.

Furthermore, as the Kaiser study shows, the state administrative offices involved in implementing the TANF work requirement over the past two decades have ended up costing the government more than it ostensibly saves through its mandatory work requirements. It costs money to hire more bureaucrats to keep track of the people it is supposedly trying to "free" from willful idleness. It's also been demonstrated that the children of parents who are forced to work at low-paying jobs in exchange for minimal benefits have more behavioral problems, thus adding to the long-term costs to society of slashing safety net programs. Having Medicaid coverage when working at jobs which provide no health insurance at all actually saves both the government and private business money, because reliable heath care helps people to keep working, especially when their jobs involve repetitive stress and heavy lifting.

The Kaiser report authors add that when the Trump administration shames the "able-bodied adults" it would like to exclude from Medicaid, it doesn't even bother to define that term. It could very well include the mentally ill, the illiterate, the drug-addicted. Nobody knows, probably least of all the incurious and semi-literate Donald J. Trump.

The one silver lining of Seema Verma's hideous agenda is that so far, anyway,  "only" eight states have expressed an interest in seeking a federal waiver for the Medicaid work requirement. Among them is economically hard-hit Kentucky, whose state-run KyNect marketplace and  Medicaid expansion were lauded as the preeminent success story of the Affordable Care Act. The number of insured people there increased by 105% over four years, the largest increase of any state. Put another way, only six percent of Kentuckians remained uninsured last year.

The other seven states opting in to the work requirement are Arkansas, Arizona, Indiana, Maine, New Hampshire, Utah and Wisconsin, all of them led by conservative officials.

Matt Bevin, the Tea Party governor of Kentucky elected in 2015, at first wanted to completely overturn Obamacare's Medicaid expansion. But such was the uproar that he "softened" his stance somewhat, and is applying for a federal waiver not only for ushering in the work requirement, but for an actual reduction in services, beginning this year.

Among the proposed new requirements for getting a prescription filled, or getting a tooth filled, is passing the high school equivalency exam and enrolling in job training classes, as well as finding the financial means to attend courses dealing with smoking cessation and other health problems. People who've qualified for Medicaid because they meet poverty guidelines will also be monitored under what is dubbed a "My Rewards" account. Health expenditures exceeding $1,000 annually will count as a demerit on one's permanent record, although any actual rewards accruing to the compliant care-avoiding patient remain shrouded in mystery.

As health reform advocate Louise Norris points out, with Bevin's plan almost guaranteed to get quick approval from the unhinged Trump administration, half a million Kentuckians will get kicked off the Medicaid rolls within five years. This will happen in a state which already has one of the highest death rates in the country from opioid overdoses: nearly 30 people out of every 100,000 last year.

Naturally, Medicaid has also become the convenient scapegoat for too many "able-bodied" adults scoring too many opioid prescriptions from unscrupulous pill mills. Carefully missing from these conversations is why people are getting hooked in the first place. Many times it's because they're out of a job, were evicted from their home, and are so bummed out that they will do just about anything to ease both their psychic and their physical pain.

  This front in the class war of rich versus poor is the bomb cyclone which will tear families and workers apart for decades, if not for multiple generations. But to hear the mass media tell it, the real emergency and the real crime is still that Donald Jr. talked to "the Russians", and that fascist provocateur Steve Bannon is calling it treasonous.

Donald Trump is far from the only nut in this party mix.

1 comment:

voice-in-wilderness said...

The worst crime that anyone can commit in the United States is to be poor. Maybe someone has created a scale that ranks crimes according to acceptance by society. I'd expect billion-dollar financial crimes to be at the top in acceptability, felonies like murder and rape to be near the bottom, but poverty to be at the absolute bottom.