Trump’s Destruction of Medicaid: Sabotage of a Five-Decade Social Contract

Medicaid was enacted in 1965 under the Lyndon Johnson administration as a social insurance program to provide lower-income Americans with the health care they need. Since then it has been solidly supported by all subsequent administrations as a social contract within our society, as a matter of fairness and necessity. As poverty and inequality have increased in more recent years, it has become a mainstay assuring necessary medical care for some 74 million Americans, covering more than one in five Americans, almost one half of births, 39 percent of children, and about two-thirds of nursing home and long-term care, and more than one-quarter of mental health services. It has been described as “the backstop for America’s scattershot health care system.”

Not anymore. The Trump administration is out to shrink the program by whatever means, now including administrative actions by the Centers for Medicare & Medicaid Services (CMS) that bypass action by Congress. Seema Verma, Trump’s appointed head of CMS, did just that in Indiana during Michael Pence’s governorship. She has recently released a 10-page memo detailing how states can apply for waivers that can rein in their Medicaid programs, even in states that expanded Medicaid since 2010 under the Affordable Care Act. Through these waivers, states can exclude able-bodied adults from coverage unless they are working at least 20 hours per week. Children and disabled people are excluded from the work requirement. Ongoing reports will be required documenting that Medicaid recipients are working. If they fail to comply with these requirements, they can be locked out of coverage entirely. These new reporting requirements will greatly increase the bureaucracy involving Medicaid.

Kentucky is the first state to receive this federal waiver. It had expanded Medicaid under the ACA and now covers more than two million people. Its waiver allows it to require Medicaid recipients to work at least 20 hours per week, and to impose monthly premiums. Some people may be locked out of coverage if they fail to pay these premiums. Nine other states are lining up to request similar waivers. Waivers can also allow states to require additional eligibility redeterminations, to eliminate retroactive eligibility, and to establish lifetime limits for coverage, such as three to five years.

– Buzz Flash

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