In the early 1960s, as the Lyndon B. Johnson administration worked to enact Medicare and Medicaid, then-actor Ronald Reagan traveled the country as a spokesman for the American Medical Association, warning of the danger the legislation posed to the nation. “Behind it will come other federal programs that will invade every area of freedom as we have known it in this country,” he said in one widely distributed speech. “Until one day…you and I are going to spend our sunset years telling our children and our children’s children what it once was like in America when men were free.”
Reagan set the tone for a conservative war against Medicaid that is now in its 52nd year. Recent Republican proposals to repeal and replace the Affordable Care Act would have reduced Medicaid enrollment by up to 15 million people, and, although these efforts were defeated, congressional Republicans aren’t done yet: It’s likely they will attempt to gut the program during the upcoming budget debate. Meanwhile, more than half a dozen Republican governors are trying to take a hatchet to the program—at the open invitation of the Trump administration—through a vehicle known as a “Medicaid waiver.”
Waivers are intended for state pilot projects designed to improve health-care coverage for vulnerable populations. But that’s not what conservative governors are pursuing. In Maine, for example, as citizens prepare to vote on a referendum that would force the state to expand Medicaid to 70,000 people, Governor Paul LePage is moving in the opposite direction. His Department of Health and Human Services has requested permission to create a 20-hour-a-week work requirement, impose copays and premiums, and implement a $5,000 asset cap on Medicaid beneficiaries. The result, health-care experts warn, will be that low-income people in Maine will be kicked off the program.
LePage’s administration argues that the work requirement will help people earn more and become more self-sufficient. But, according to Hannah Katch, a senior policy analyst at the Center on Budget and Policy Priorities and a former administrator of the California Medicaid program, 80 percent of Medicaid patients nationwide are already in working families. “The vast majority of people who aren’t working are either taking care of a family member, have a physical or behavioral health condition, or are in school, or have a combination of these factors,” said Katch. “While a work requirement is unlikely to help them get a job, it is very likely to take away health coverage from people who can’t work.”