Cruelty makes for really stupid policy

But, alas, Republicans seem more interested in cruelty than they are in good policy.  Catherine Rampell on the moral and policy fiasco that is Arkansas work requirements for Medicaid:

This summer, Arkansas became the first state to require poor people to prove they’re employed to receive Medicaid.

Critics say the state is trying to save money on the backs of the poor. That’s nonsense, Arkansas officials reply. They want to help  the poor. Backed by the Trump administration, they are inspiring slackers and moochers to climb the economic ladder…

Consider Adrian McGonigal, who is challenging the policy in federal court.

McGonigal, like most non-disabled, nonelderly Medicaid recipients, had a job. Full time, too, at a chicken plant. The plant’s chemicals sometimes aggravated his COPD, a chronic lung disease, but his employer accommodated the condition by moving him from processing to shipping.

More important, McGonigal’s prescription medication — funded by the state’s Medicaid expansion, since his job didn’t come with health insurance — kept his symptoms in check.

McGonigal was unclear about what he needed to do to report his work hours, or if he had to report at all. The new policy applies only to Medicaid expansion enrollees, but even most people in that group don’t have to frequently check in with the state (because of age, disability, state already has work information on file, etc.). Like many I spoke with, McGonigal says he got confusing and sometimes conflicting information from the state’s Department of Human Services, which told him to report online. He doesn’t have a cellphone or computer, so he borrowed his sister-in-law’s smartphone.

“I thought that everything was good,” he told me in an interview for The Post and “PBS NewsHour.” “I thought it was just a one-time deal that you reported it, and then that was it.”

It wasn’t.

The state wanted him to report  monthly . He learned this only when his pharmacy told him his insurance had been canceled. After that, he couldn’t afford his medication. His COPD flared up and he landed in the emergency room. And he missed lots of work…

In other words: A policy intended to help people get jobs instead cost McGonigal his. 

This was predictable. A Hamilton Project report found that the preponderance of evidence suggests Medicaid has little or positive effects on labor-force supply. For many families, safety-net services support work, rather than discourage it.  [emphasis mine]

Exactly, this is no, “oh, my, how could we have seen it coming” unintended consequence.  This is an entirely predictable consequence.  It’s almost as if Arkansas Republicans don’t want the working poor to have health insurance.  Let’s save that for old people and Wall Street Bankers, etc.  Ugh.  Just so frustrating when a policy is so willfully cruel and willfully misguided at the same time.

Rampell also has a follow-up where she considers whether maybe the idea is okay, but Arkansas is just implementing it very poorly.  Well, the latter is true, but even then, it is just stupid, stupid policy:

Could you then formulate a policy that wouldn’t be so dysfunctional or cause so much accidental hardship? Could you have a compassionate, thoughtful system that truly punishes only the lurking shirkers?

Only if you want much bigger government, which conservatives generally don’t.

Most nonelderly Medicaid enrollees are already working, according to a Kaiser Family Foundation analysis. Almost all of those who aren’t working have a pretty reasonable explanation for why not, such as disability, family obligations, school attendance or no work available.

Finding, documenting and ultimately punishing the tiny minority of Medicaid recipients whom officials target as “undeserving” would therefore require a major, costly expansion of the administrative state. And, in fact, Arkansas already knows this. That’s why officials made the reporting system online-only, after all, and presumably why they didn’t bother to bring its database software into the 21st century: to save money.

This, this, this!!!  Conservatives are always ignoring these very real monitoring costs.  Yes, we should prevent obvious fraud and abuse, but if you want to catch every last fraudster you reach a point where the monitoring costs become prohibitive and entirely counter-productive.  And you fully ensure that many worthy people will not receive the service for which they are entitled.  Stupid, stupid, stupid.

On a personal note, my son recently received a Medicaid waiver (after 11 years on the waiting list) for certain services due to his lifetime disability.  My wife has 1) a PhD, and 2) time to get stuff done during the day.  And, yet providing all the documentation to ultimately receive the waiver was absurdly confusing and incredibly onerous.  And, again, this is a very smart person who had the free time to dedicate to it.  Imagine a poorly-educated person who is spending all their time just trying to get food on the table and keep their head above water.  People like that, often end up without the services they are qualified for.

Here’s the simple reality as I see it.  If there’s any government program people will always try and cheat the system.  And here’s the trade-off, the harder you make it for the cheaters, the harder you make it for the deserving beneficiaries.  Sure, I don’t like the cheaters, but I accept that as a simple, but unfortunate, cost of helping those we want to help through the program.  Sadly, many Republicans are so intent on stopping the cheaters that they create the cost of not helping the people who need the help.  Then, of course, they deny that’s what they are actually doing.  This is why so much social welfare policy in America is so messed up.  Yeah, people cheating the system sucks.  But what sucks worse is people needing help and not getting it.

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