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.

About Steve Greene
Professor of Political Science at NC State

3 Responses to Cruelty makes for really stupid policy

  1. Nicole K. says:

    Yeah, reminds me of how the Trump administration realized that people in non-medicaid expansion statesbwith incomes lower than the poverty line were routinely overstating their incomes in order to qualify for Obamacare subsidies that allowed them to get affordable insurance. The Obama administration had made a point of over looking this because the law allows for the subsidies to be given to people with incomes too low unless they are disqualified at the time they applied for the subsidy.

    So, of course, the Trump administration decided to ensure that people actually had an income of at least $12,500 to get an obamacare subsidy beginning this year. That means that my family will have to absorb an additional $10,000+ in health insurance premiums for me because while I am in graduate school and managing a serious chronic illness, it is not possible for me to earn $12,500 and do well in school. I can either do well in school, which will allow me to earn a much higher level of income in about a year or so, or I could work to earn enough money to get subsidized health insurance. I can’t do both because narcolepsy severely limits the amount of time I am able to work before I am exhausted.

    Fortunately, my family is able to help me absorb the cost of of my insurance next year because without it I can neither work or attend school. I do not understand this preoccupation with making life harder for poor people, especially when they are doing everything possible to no longer continue being poor.

  2. itchy says:

    “Yeah, people cheating the system sucks. But what sucks worse is people needing help and not getting it.”

    I love this. The perfect tl;dr;

    • Nicole K. says:

      You did kind of nail it with your tl;dr.

      I am lucky to have parents who, while it’s not exactly painless for them, love me and are willing to do what is necessary for me to be able to get my master’s degree that is necessary for me to gain employment that allows me to actually be financially independent. I just feel really bad for those who have been getting insurance for the past 4 years and are now in for a bad day when their subsidy is terminated in February because they are unable to provide the now required proof of income that backs up their estimate by the deadline at the end of January.

      The website is not explicit about what will happen if you do not submit the required proof by the end of January and allows you to proceed with your enrollment with nothing more than a less than clear explanation of what the plan converts to.

      Due to the fact that cost sharing subsidy funding is no longer coming from the government, the best silver level plans for those who get both types of subsidies, convert into extremely high deductible, $700 monthly premium, and $7,500 out of pocket maximum. The Gold-tier plan is a much lower deductible for the same premium, but if you don’t proactively select that plan before the end of open enrollment and lose your subsidy, without a qualifying life event, you are stuck with the unsubsidized version of the silver plan as your only option. Plus, most people with annual income of less than $12,500 probably do not have parents ready to jump in and help them out, so it likely won’t make any difference and they will just lose coverage.

      So February is going to suck for a lot of people who don’t understand what is going to happen to their health insurance. I almost wonder if they are doing it this way on purpose to delay most of the pain until well after open enrollment closes and less attention is being paid to the issue.

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