Do the Poor Deserve Decent Health?

Between 2013 and 2016, the state of Kentucky experienced a veritable medical miracle. Five years ago, at the start of that span, two of every five low-income people in the state had no health insurance. By the end, only one in every thirteen poor Kentuckians were going uninsured.

What difference did this increased insurance coverage make? The share of low-income people in Kentucky getting annual check-ups increased by a nearly a third, the share reporting themselves in “excellent health” jumped by over half.

And what generated this medical miracle? Kentucky simply expanded who could qualify for Medicaid, funding this expansion with dollars from the Affordable Care Act, the landmark legislation more commonly known as Obamacare.

A great deal, unfortunately, has changed since 2016. Republicans hostile to Medicaid now have a lockgrip on public policy in both Kentucky and Washington. In mid January, these hostiles turned that lockgrip into a hammer — on Medicaid recipients.

Trump administration officials have given their Kentucky counterparts a “waiver” from existing Medicaid regulations that will, the Center for Budget and Policy Priorities documents, “reduce the number of people with health coverage and make it harder for those covered to get care.”

The rationale behind the waiver? Officials in Kentucky are claiming that Medicaid needs a “work requirement.” But that makes no sense. The vast majority of Medicaid recipients in Kentucky, 77 percent, are already working. Most of the rest either are taking care of elderly relatives or disabled kids or have disabilities of their own.

No matter! The hunt for Medicaid malingerers in Kentucky will now move ahead, along with other changes that will hit the state’s Medicaid recipients with new co-pays and premiums. All these changes will create a mountain of required paperwork. And if recipients make a mistake on this paperwork, or miss a filing deadline, they’ll lose Medicaid coverage for six months.

Many Medicaid recipients will no doubt quickly get lost in Kentucky’s confusing new waiver rules. State officials are, in fact, counting on that confusion. They’re proudly predicting 1.14 million annual lost Medicaid coverage months by their waiver’s fifth year in effect.

The obvious question: Who’s driving the pols who run Kentucky and Washington to complicate — and cut — Medicaid? The rarely acknowledged answer: America’s wealthy right-wing ideologues. These exceptionally deep pockets expect the elected leaders they bankroll to press the poor all-court.

This pile-on-the-poor ideology of America’s awesomely affluent spews out from the “think tanks” and academic centers they so lavishly subsidize. The hired hands at these outfits do all the heavy lifting on moves like the Kentucky Medicaid assault. They write the talking points and the legislative language. Then the media outlets the rich underwrite finish the job. They demonize poor people as lazy laggards ever ready to snatch away and waste hard-earned taxpayer dollars.

This demonizing has been ratcheting up ever since the Reagan era. The richer America’s rich become, the fiercer the assault on the safety net programs that bring decency to America’s most vulnerable.

Why should that be the case? Billionaires living in a society where many millions of people have no wealth — and shaky health — have a choice. These rich can consider their own personal wealth the product of a deeply flawed society that needs fixing. Or they can consider their good fortune a well-deserved reward for their own “superior” intellect and effort.

Those rich who do feel superior will almost inevitably come to see people without wealth as inferior, as lazy no-accounts who deserve no “rewards” — not even health care coverage.

And all that talk about the “dignity” of work that pols love spouting as they rip the social safety net? They don’t really mean it. They have no problem with the idleness of the super rich, as demonstrated once again this past December when conservative members of Congress shoved into law federal tax “reforms” that increase the amount of money that the lazy, no-account progeny of billionaires can inherit.

Tax-free, of course.

Sam Pizzigati co-edits Inequality.org. Among his books on maldistributed income and wealth: The Rich Don’t Always Win: The Forgotten Triumph over Plutocracy that Created the American Middle Class, 1900-1970. His latest book, The Case for a Maximum Wage, will appear this spring. Follow him at @Too_Much_Online.