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Republican Incompetence Prevents Enactment of South Dakota Medicaid Work Requirement

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.

In Arkansas, one of the few states where work requirements got a trial run before a sensible court said stop, Medicaid work requirements produced none of their claimed advantages:

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.


  1. Donald Pay 2021-02-15 10:12

    Thanks for this post. Four years of fascism was hard to live through, but you remind us that there could have been a competent fascist in the White House. I had thought at one time that Pence would be better than Trump, but, yeah, if you have to have a fascist in the White House, best tove an incompetent one.

    The Republican idea that people on assistance don’t want to work is something only an elitist could come up with. They don’t have a clue about how people live. I worked 16 years in vocational rehabilitation, finding positions for people who had disabilities or other challenges. Most were on some sort of aid. There were a few people in all that time who rejected work that was offered to them. Most of those rejections were understandable: transportation or childcare difficulties that couldn’t be overcome. A few had crushing anxieties or other mental health issues. Some could do jobs, but had criminal records or used substances, so they were automatically rejected for jobs. Very, very few give up and most folks keep trying to find jobs. A lot of folks find it easiest to do seasonal work, going from job to job as employment opportunities open and close over various seasons.

    My experience with a lot of folks in this position is that they desperately want to work. People get self-worth and good social outlets from working. But it’s gotten much harder to apply for work. In many cases it’s all done on-line. No computer, no job. Then there are the stupid personality and screening tests. Don’t get me started. If you fill out a paper application, they automatically reject you because it can’t be scored by corporate human resources flunkies. You want people on assistance to work? Ban on-line applications.

  2. bearcreekbat 2021-02-15 10:48

    Donald’s post reminds me of one individual’s terse and telling response to one of Don’s “elitists” in a case I personally witnessed. A life long hard working older truck driver severely injured his back during a particularly difficult and strenuous trip. He could no longer do the heavy lifting and physically demanding labor required to drive trunk, and his constant and recurring back pain made it difficult to sit or stand for any length of time. After unsuccessfully trying several different jobs he finally reluctantly applied for the social security insurance disability benefits that he had been paying for during his entire working life.

    At the time most applicants with back injuries were required to present their cases to an administrative law judge (ALJ) during an evidentiary hearing because the local office typically rejected such claims. The ALJ that heard the driver’s case happened to be a hard core conservative that also doubted that a back injury could ever prevent someone from working.

    A vocational expert testified, explaining that there was no suitable work for the truck driver due to the driver’s medically documented symptoms, failed attempts at new and different types of work, advanced age and limited education. The hostile ALJ still wasn’t satisfied with the expert medical and vocational evidence and harshly cross examined the driver, pointedly demanding:

    “Can’t you think of at least one job that you could do?”

    The driver thought for a while, looked at the ALJ and responded:

    “I could do your job.”

    The ALJ blustered and ended the hearing, ruling against the driver. The federal court summarily reversed the ALJ and ordered the driver’s social security disability insurance benefits be awarded.

  3. mike from iowa 2021-02-15 11:07

    bcb’s retelling of a story must have been from dumbass dubya’s reign of terror on disabled persons. I hear from a SS trained lawyer that dumbass’ crew was turning virtually everyone away regardless of condition(s).

  4. bearcreekbat 2021-02-15 11:40

    mfi, it goes back even further to the Ronald Reagan years early in the 1980’s.

  5. Donald Pay 2021-02-15 11:43

    Yeah, bcb, there are some hard-ass elitist who think that sitting in a hearing or meeting is “hard work.” They look down their nose at people who clean their restrooms, but would they lift a hand to do those jobs? Hell, no, they wouldn’t. If they were laid off their cushy jobs, they would collect their unemployment rather than take a job unplugging toilets. I hate those people with a passion, and they are all Republicans.

  6. Mike Livingston 2021-02-15 12:15

    Trumpoholism symptoms inability to grasp reality, constitutionally unable to tell the truth ect ect.

  7. mike from iowa 2021-07-04 11:32

    drumpf spilled the beans of how how dupes magats into believing his lies, and did this in front of magat crowd in Sarasota Florida last evening. Priceless….

    On Saturday, during a campaign speech in Florida, Trump inadvertently explained exactly how he was able to dupe so many of his supporters into believe his nonsense.

    “There’s a word: disinformation. If you say it enough and keep saying it — just keep saying it — and they’ll start to believe you,” Trump explained.

    Never thought I’d live long enough for drumpf to tell the truth.

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