By Kim Bellard
So the house has passed Their ‘big, beautiful bill’, due to the narrowest margins. Crucial for the bill are great savings of Medicaid, who would have taken some joy in recent years, but now they are careful to explain if only cutting “waste, fraud and abuse”, after they finally realized that many Maga voters are dependent on Medicaid.
Many of those savings come from proposed work requirements for medicaid recipients, a favorite republican tactic that the Biden -Administration continued to reject. Speaker Mike Johnson is very pronounced about their interest. The people who are affected by the work requirements, he stood on Confronted with the nation:
If you can work and you refuse to do this, cheat the system. You cheat the system. And nobody in the country believes that that’s right. So there is a moral part of what we do. And if you let young men work, it’s good for them, it’s good for their dignity, it’s good for their self -esteem, and it’s good for the community in which they live.
He is convinced That, instead of working, too many of them – especially young men – “play video games all day.” He and other republicans want to bring Medicaid back to what they see as the original goal: “It is meant for young, you know, single, pregnant women and the handicapped and the elderly,” speaker Johnsom said. “But what is happening now is that you have a lot of people, for example young men, valid employees who are on Medicaid. They don’t work when they can.”
He is generally right that Medicaid was not really a program for the poor for the most of its existence as for certain types of poor people, especially pregnant women and children with a low income, and the medically impoverished. It took Obamacare to increase coverage for all people below the poverty line, although the Supreme Court allowed states to decide whether they wanted to do this, and ten states still don’t have.
It is indeed a moral question, simply not the kind that speaker Johnson likes, about whether there is a moral need to give more people, especially poor people, health coverage.
The issue of these non-working medicaid recipients is something of a shibboleth. Kaiser Family Foundation for example, found “That 92% of Medicaid adults work (64%) or have circumstances that can qualify them for an exemption.” A 2023 CBO -analysis Put doubts that such work requirements would not have much impact on the number of Medicaid recipients. Work requirements are a solution looking for a problem.
What we do know About work requirements, from distance statement programs in Arkansas and Georgia, is that they indeed reduce the number of people on Medicaid, but largely by making it more difficult to verify suitability. The requirements are confusing, the processes that the recipients/potential recipients must follow are cumbersome, and the mechanisms needed to supervise are duration (or, depending on your perspective, lucrative for some suppliers).
It’s not about having people work on Medicaid, and it’s not about “waste, fraud and abuse”; It’s about registering fewer people for Medicaid.
The calls to bring Medicaid back to its original goal seem very self -service. For example, Medicare originally did not cover people with ESRD or disabled people under 65 hours. Social security originally did not cover farm workers or independent employees and did not include any benefits for people with disabilities or survivors of retired persons (spouses and children). We can save a lot of money by bringing those programs back to their original purposes, but those are bridges that Republicans are not yet ready to cross … yet.
If we think that Medicaid is not the right program for many poor people, well, that is a fair discussion. Medicaid has more than the share in problems, not least are low reimbursement percentages in most states and a resulting lack of participating care providers. Many poor people can indeed be better served by simply having them register for an ACA plan.
Unfortunately, however, ACA was not designed for poor people, the premium subsidies and costs for sharing costs do not apply To people with an income under the federal poverty. It was believed that such people would all be covered by Medicaid extension. Of course, people with a low income can get an ACA plan, but it is difficult to see how they can afford the premiums or to pay for deducts/coins insurance for care they can receive.
Perhaps that low incomes, video game that young men play can make jobs, but there is a good chance that their employers would not offer health insurance, or, even if they did, the required premium contribution of employees would be priceless, whether they could try to get an still priceless ACA plan. For better or worse, in the complicated system we have the best place for them.
The moral component that speaker Johnson and others – of whom many claim to be pious Christians – seem to miss that in the richest country in the world no one should not get the health care they should have because of the costs. The best way the US found that to achieve that – and it is a wild imperfect solution – is to get more people who fall under a form of health insurance. ACA cut the number of people without insurance, but that still leaves Almost 30 million people without cover.
The “big, beautiful bill” is estimated To add another 10 million people to the ranks of the uninsured, most, but not all would result from people who lose medicaid. It is also possible, oh-by-the-way, Further Cripple Safety Net Hospitals and ProfessionalsFurthermore, aggravating the impact.
So if you hear Republicans talking about “waste, fraud and abuse” in Medicaid, they are saying that some people don’t deserve to get health care (similar snapsnijders mean that some people don’t deserve to eat). I have a hard time with that, and I don’t even have to check my Bible to be pretty sure that it is morally wrong.
Whether those people play video games or not.
If they want to go after fraudulent invoicing, over -treatment, bribe, etc., yes, I am completely on board to focus on that type of waste, fraud and abuse. But poor people are kicking when they are already finished, no.
Kim is a former emarketing -exec at a large blue plan, editor of the late & complains Tinctuur.ioand now regular THCB employee
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