Here’s another example of how Donald Trump’s own self-absorbed incompetence saved us from a totally oppressive regime over the last four years.
Back in 2018, Governor Dennis Daugaard proposed requiring Medicaid recipients to work for their benefits. (Remember, this is the same Republican Governor who blew smoke about wanting to expand Medicaid in 2014; obviously he and his Republican friends couldn’t stand that impression of compassion for very long and got back to their core values of helping fewer people.) Daugaard wanted to start with small pilot programs in Minnehaha and Pennington counties, just to prove how much fun oppressing the poor can be in the big towns with newspapers before launching the program statewide.
It’s hard to tell what vast swath of lazybone moochers Daugaard and Trump thought they were tackling. According to a new Kaiser Family Foundation issue brief, 43% of “Medicaid adults” were working full-time in 2019; 20% were working part-time. 12% were not working for pay because they were caring for family at home. 10% couldn’t work because they were sick or disabled. 7% were going to school instead of working. That left 7% who were not working “due to retirement, inability to find work, or other reason.”
But to impose that Medicaid work requirement on even that 7% of dubious laggards, South Dakota needed a waiver from the Center for Medicare and Medicaid Services. South Dakota applied for such a waiver in July 2018… and the Trump Administration took no action. Since February 2020, no states have submitted new Medicaid waiver applications (in part because they were seeing work requirements lose in court), so CMS had all of last year to clear its inbox… but as of January 26, South Dakota’s Medicaid work requirement proposal still sat on CMS’s shelf with six other state waiver requests.
Now if the Republicans had nominated an actual President, a competent leader focused less on tweeting insults for attention and more on implementing conservative policies, you’d have seen the President reading his morning briefings, following up on his Medicaid work plan, and pushing his appointee at CMS to clear any backlog and immediately authorize states to engage in his great experiment in Medicaid reform. Instead, Republicans picked a leader who occasionally mouthed approval of their agenda but lacked the ambition, attention span, and able appointees necessary to implement sweeping policy changes. Had Republicans not succumbed to their cult of personality in 2016, had they gotten wise early and backed a 25th Amendment replacement right after the first crazy lies about the size of the 2017 Inauguration, they’d have seen President Mike Pence sign every Medicaid waiver himself, gut Medicaid and Medicare to double the tax cuts for the wealthy, and take us all the way to The Handmaid’s Tale.
Fortunately, the Republicans have defaulted to kakistocracy, which leads us to death on the highway and in the halls of the Capitol but not to effective processing of state Medicaid waivers… all of which real President Joe Biden is now rescinding, because they don’t work.
Arkansas enrollees reported that new work requirements did not provide an additional incentive to work, beyond economic pressures to pay for food and other bills. Another study found that work requirements in Arkansas did result in significant changes in employment. Among individuals who may find work, low-income jobs are not likely to come with employer-sponsored health insurance (ESI). Nonelderly workers with incomes below 100% FPL were the least likely to be offered coverage at their jobs compared to those with higher incomes in 2018. Very few part-time workers, especially those with low-incomes, receive an employer-sponsored offer of health benefits [Rachel Garfield, Robin Rudowitz, Madeline Guth, Kendal Orgera, and Elizabeth Hinton, “Work Among Medicaid Adults: Implications of Economic Downturn and Work Requirements,” Kaiser Family Foundation, issue brief, 2021.02.11].
Medicaid work requirements took away health coverage, endangered disabled Americans, and reduced access to care. An able and ambitious conservative President would have wrought that harm on every state and made it sound like a great idea. Instead, Republicans picked Donald Trump, who left South Dakota’s application to abuse the poor on the shelf, collecting dust with several other states’ anti-social, counterproductive proposals.
So, yes, thank goodness for the incompetence of the modern Republican Party.