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  November 9, 2017

Trump Admin Pushes Work Requirements on Medicaid Recipients

The Trump administration will back efforts to impose work requirements on Medicaid participants, creating a new obstacle to healthcare for vulnerable people, says Michael Lighty of National Nurses United
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Michael Lighty is the Director of Public Policy for National Nurses United and the California Nurses Association. Michael is also a Fellow at the Sanders Institute. He has served on the Oakland Planning Commission, and on community, education and political organizations' boards of directors. He was the first openly LGBTQ Commissioner for the Port of Oakland.


AARON MATÉ: It's the Real News. I'm Aaron Maté. Medicaid offers free or low cost healthcare to millions of Americans, including families, low income earners and people with disabilities. This week, the Trump administration announced a change. In his speech, Seema Verma, the administrator for the Centers for Medicare and Medicaid Services or CMS said "State will be encouraged to promote work requirements for Medicaid recipients."

SEEMA VERMA: Believing that community engagement requirements do not support or promote the objectives of Medicaid is a tragic example of the soft bigotry of low expectations consistently espoused by the prior administration. Those days are over.

AARON MATÉ: I'm joined now by Michael Lighty, Director of Public Policy for National Nurses United. Michael, welcome. Let's start with what we just heard. The implying there that not imposing work requirements is a form of "soft bigotry."

MICHAEL LIGHTY: Yeah, it's just outrageous, Aaron. The notion that somehow we need to impose more barriers to care and more barriers to accessing health care and if we don't impose those barriers, somehow we're bigots? It is really the most perverse kind of Orwellian logic applied to health care but this administration's got everything backwards. Less is more to them. Barriers to care, equal access to care. It's just an odd universe that they live in, which actually has nothing to do with the reality that people face when trying to get the care they need.

AARON MATÉ: So, let's break down what exactly this entails. You have a number of Republican states right now applying for waivers to Medicaid rules. This speech this week was a way to say the Trump administration will approve those waivers and allow work requirements for Medicaid recipients. So, what does this look like exactly?

MICHAEL LIGHTY: Well, what it looks like is the states would be able to set work requirements, or what they call these community engagement requirements and if you do not fulfill those requirements, you would lose Medicaid. In addition, it signals that there are other waivers that the Obama administration had declined that the Trump administration may very well approve. That is waivers that would impose additional requirements. Perhaps even capping the years that you can be on Medicaid, limiting the access to individuals who make over the federal poverty line, currently the requirement is you have to cover through 138 percent of federal poverty level. You might also see facing eligibility on drug screening. Other impositions include income premiums that people wouldn't be able to afford.

All those kind of waivers that reduce access to care but also of course, reduce the spending that the states have. The specific community engagement, or work requirement, could be very odorous and the truth is, Aaron, 59 percent of able bodied people on Medicaid now already work. 78 percent of those able bodied Medicaid recipients are, or actually 78 percent of all Medicaid recipients are in households where somebody works. So, it's a solution, so called, in search of a problem that actually exacerbates access to care.

AARON MATÉ: Right. And yet, the ways the recipients are described, it's so heavily mythologized. I wanna go to one more clip from Seema Verma's speech where she talks about Medicaid perpetuating a cycle of generational poverty.

SEEMA VERMA: We owe our fellow citizens more than just handing them a Medicaid card. We owe a card with care. And more importantly, a card with hope. Hope that they can achieve a better future for themselves and their families. Hope that they can one day break the chains of generational poverty and no longer need public assistance.

AARON MATÉ: That's Seema Verma, the administrator of CMS. Michael Lighty, not just giving people a card with care but a card that conditions that care on them trying to find work. And the message there is that then will give them hope.

MICHAEL LIGHTY: Yeah, it's a pretty interesting and false assertion. Somehow, we've got folks just lying around getting their Medicaid and not [inaudible 00:05:08]. And of course, there's a lot of these states that are seeking these kind of waivers, like Indiana, heavily rural state, where the jobs are few and far between in many of these rural areas. And so there are real problems with the American economy, with the structure of the economy that limits job opportunities, that keeps people in poverty through lack of good high paying jobs with a living wage and health benefits.

So, let's address those structural problems in the economy before essentially blaming the individual for the fact that jobs are not available in their communities. It's quite, we know, in fact, that unemployment is a problem that increases health risks. And the notion that people are voluntarily or for generations by their own choosing unemployed is of course a tenent of conservative dogma, but it bears no relationship to what working people in this country actually experience, and have experienced for decades.

Also, I think it's quite ironic that the administrator of CMS, who comes from Indiana, which essentially because of their own social conservative agenda let an opioid and HIV epidemic sweep through much of the state. They're now lecturing the rest of the country on how to organize access to health care. It's ironic, it's perverse and it simply won't work.

AARON MATÉ: Meanwhile, you just had this vote on Tuesday when voters in Maine, in defiance of their governor, Paul LePage, voted to go with the Medicaid expansion that was enacted under Obamacare. So, a sign right there that at least in one state, the electorate is opposed to the Trump agenda on Medicaid.

MICHAEL LIGHTY: That's right. The only people who are gonna like this community engagement work requirement of course are the conservatives in different state legislators who just wanna cut spending on the poor and give tax cuts to the rich. On the other hand, people, voters like in Maine and elsewhere have expressed strong support for expanding Medicaid. And we expect in Virginia that to happen as well because of the overwhelming result in the gubernatorial election. And in fact, health care was the top issue in Virginia, and they voted for the candidate who favored Medicaid expansion. I think one of the most extraordinary things in the last year, Aaron, is how popular Medicaid has become because it really is a sign of the desperation of folks, particularly low income working folks, who literally have no other option to get health care. And for disabled people it is literally a matter of life and death. Medicaid is really our safety net and this community engagement so called program just helps to shred it. And it's universally, I think, going to be rejected if people have anything to say about it.

AARON MATÉ: Right. And, if the Trump administration approves these waivers from these states that wanna impose work requirements, I imagine there’ll be lawsuits challenging that. How do you expect that to play out?

MICHAEL LIGHTY: I think that's right, Aaron. I think there will be lawsuits and rightly so. The reality is that, yeah, under the Roberts decision which limited the Medicaid expansion under Obamacare, it's been left up to the states. But at the same time, that doesn't mean that the states can simply impose requirements that have nothing to do with legitimate eligibility. Medicaid is not some program to be used for conservative social engineering agenda to punish poor people because they can't find work in an economy that doesn't provide good jobs. Instead, Medicaid is a program to make sure that we have a base level of care in this country, and that, those two notions: you're gonna use it as a social engineering program for conservative dogma versus what it's real intent is, which is to provide healthcare to people in need, I think the real intent will prevail.

AARON MATÉ: Michael Lighty, Director of Public Policy for National Nurses United. Thank you.


AARON MATÉ: And thank you for joining us on The Real News.


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