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The Trump administration has told states they can cut off Medicaid benefits unless recipients meet work requirements. Michael Lighty of National Nurses United calls it an “authoritarian social engineering project” that targets the most vulnerable

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AARON MATÉ: It’s The Real News, I’m Aaron Maté. The Trump administration has already threatened the healthcare of millions of people with its attacks on Obamacare, and now it’s going after more. The administration has issued a guidance that tells states they can cut off Medicaid benefits unless recipients meet work requirements. It’s the first time in Medicaid’s 50-plus years that this guidance has gone into effect. Michael Lighty is Director of Public Policy for National Nurses United. Welcome, Michael. Let’s start with what exactly this guidance is. What has the Trump White House told the states?
MICHAEL LIGHTY: Well, the Trump White House has told the states you can require people who receive Medicaid health benefits to work as a condition for receiving those benefits, effectively turning Medicaid into something it has never been, which is a welfare program. And it’s a fundamental change to its design and approach.
AARON MATÉ: So what does now someone who’s on Medicaid in one of these states – I believe the first state might be Kentucky – what does someone on Medicaid who currently is not working face in their daily life as a result of this?
MICHAEL LIGHTY: Well, they face — in addition to whatever health challenges they also experience, which of course, that Medicaid population tends to have more chronic conditions — higher health needs because in this country social and economic factors are the largest determinants of health status. And so a low-income population, which Medicaid is, is by nature of the inequality and injustice in this society, going to be less healthy. So they will confront those challenges first of all.
And then secondly, as we know there’s a great disconnect between where many poor people live and where the jobs are, so they’ll face massive transportation and logistics obstacles to getting employment. The first thing they’ll face is a threat from the state of Kentucky or other states who say unless you’re able to secure employment by X date, you will lose your healthcare coverage. I mean this is a self-defeating approach, because, of course, these less healthy people will become even less healthy. How are they going to be employed, if they are even in worse shape in terms of their health? So it’s quite problematic in terms of the barriers set up. And we know about healthcare, Aaron, is that we know the more barriers you set up that are financial, logistical, cultural; those barriers will determine, ultimately, health status that can cost people their lives.
AARON MATÉ: So Michael, the official overseeing all this is Seema Verma, and Verma gave a speech a few months ago previewing this plan. And this is what she said:
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: So that’s Seema Verma, the head of the Centers for Medicare and Medicaid Services. Michael, if you could respond to that, her saying that the days of “the soft bigotry of low expectations” are over.
MICHAEL LIGHTY: Yes. And they’re being replaced by an authoritarian top-down approach that will eviscerate social safety-net programs and put people in the streets. And that is, I think, best exemplified by both their attack on Medicaid, which disabled folks realized was a direct threat to their lives and therefore protested against them. And the only bigotry going on here, Aaron, is the bigotry of an administration that says poor people do not deserve the same standard of care as others. And so, if you’re poor, new requirements will be imposed. You will have to work. You will only be able to go to certain doctors. That’s what so much of Medicaid is in the state of Indiana where the CMS administrator comes from. There have been huge profit gouging by private insurers. So the kind of bigotry that this policy reflects is discrimination against people in favor of insurance company and corporate profits.
And their view is essentially, they want to social engineer people’s access to health. And so again, what we have rather than low expectations, we have a authoritarian social engineering project to say that these are the people who must be singled out and required to “engage in their community” as a condition of having healthcare. It’s the exact opposite. Do we say that in order to have fire services, if you live in a poor neighborhood, you have to go to work? Healthcare is a public good. It’s not a program based upon the social engineering dictates of an authoritarian government who wants to impose its will on the states, and that’s what this policy represents.
AARON MATÉ: So Michael, I noted in my intro that this is the first time in Medicaid’s more than 50 years of being in existence that there has been this work requirement imposed, but it’s not the first time in the history of U.S. federal assistance that work requirements have been mandated. And the major case was in the mid-’90s when President Clinton, a Democrat, signed work requirements as a part of so-called welfare reform. So I’m wondering, can we not just be blaming Trump here, but did Clinton’s move, endorsed by many Democrats working with Republicans, was that a predicate for this move today?
MICHAEL LIGHTY: Certainly, it is. It has to be understood as that, Aaron. And the problem is that Medicaid is not a welfare program; it’s a healthcare program. And it’s a program that is jointly paid for and administrated by the states and the federal government under the Affordable Care Act, a huge expansion of the federal contribution. So it’s really, in that sense, it’s different.
Now, on the other hand, the kind of work requirements that are imposed in AFDC [Aid to Families with Dependent Children] have been completely counterproductive in many cases because the same is true for those folks as it is for many on Medicaid, is that the barriers to employment are not individual; they’re structural, they’re social. And so to impose a requirement to overcome barriers that are actually not under an individual’s control is a kind of neoliberal social engineering that was reflected in the Clinton administration’s so-called welfare reform and in this this Medicaid work requirement. Though again, it is an escalation of that trend because it’s turning Medicaid into something it’s not, and it also is jeopardizing people’s health status and lives just as the other cuts jeopardize their access to food and shelter.
So you do see commonalities and you also see the difference, and what we can, I think, speculate as well is that this attempt to taint Medicaid, in a sense, by saying that it’s going to people who are undeserving, and until they prove they’re deserving by doing community engagement we’re not going to give them any benefits, that mentality is in direct counter-position to the general support that people felt toward Medicaid as a result of their greater awareness of the role that it plays in seniors’ and the lives of disabled folks.
Most of the spending on Medicaid is devoted to seniors and the disabled. Most of the people in Medicaid are children. I think there’s a … When the CMS administrator refers to “soft bigotry of low expectations,” I think she’s being bigoted in the sense that she’s assuming that that Medicaid population is of a certain demographic, and in fact, most Medicaid recipients are white. And I think that this is an attempt to undermine Medicaid, characterizing it as a welfare program for the undeserving poor until they prove they’re worthy, and that dynamic is destructive socially and really is intended to undermine support for Medicaid, I think.
AARON MATÉ: We’ll leave it there. Michael Lighty, Director of Public Policy for National Nurses United. Thank you.
MICHAEL LIGHTY: Thanks a lot, Aaron.
AARON MATÉ: And thank you for joining us on The Real News.

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Michael Lighty is a founding Fellow of the Sanders Institute, and currently serves on the Lancet Commission on Public Policy and Health in the Trump Era. Lighty has advocated, organized and developed policy for healthcare reform nationally and in California for nearly 30 years.