Seeking a new charade

Gov. Asa Hutchinson happened to be in the Oval Office with President Biden on Friday. On that day, the Biden administration was notifying Arkansas and other affected states that they no longer could use federal waivers as permitted by the Trump administration to impose work requirements on their Medicaid expansion populations.

I asked the governor if he’d mentioned the matter to the president. He said there had been no opportunity. The meeting had been called solely on dealing with the pandemic. He was there with New York Gov. Andrew Cuomo to represent governors generally as well as Arkansas specifically.

Cuomo is the current chairman of the National Governors Association, and Hutchinson is the vice chairman who will ascend later this year.

It would not have amounted to anything if Hutchinson had mentioned it. A Medicaid work requirement represents a stark cultural disconnection across a vast chasm.

The current Washington is on one side. The current Arkansas is on the other. You can’t get from one to the other without taking the long way.

Democrats are committed to universal health care. Red states want to punish poor people for being so no-account as to need federal help.

The Obama administration provided in the Affordable Care Act for states to receive generous federal matching money if they chose to expand their Medicaid populations to include more than the very-most poor, but also those who earned a little money, up to 138 percent of the federal poverty line.

Notably among red states, Arkansas chose during the Mike Beebe administration to expand Medicaid, but with a waiver to use the money to put recipients on private health insurance.

Then along came Hutchinson to save the innovative and nationally regarded program because it was good for the state budget, for rural hospitals, for private insurance premiums and, oh, by the way, for poor people.

But, to do so, Hutchinson had to promise his substantial and ever-growing right flank that he’d seek a waiver from the new Trump administration, which he got. The waiver particulars required recipients to report monthly that they were working or looking for work or getting up off their backsides and volunteering.

Arkansas became the first state to implement such a program. It was a pure disaster, revealed as utter rightwing window dressing with a mean streak.

Poor people were supposed to go online monthly and find a portal and click around. They didn’t. They didn’t know they were supposed to do so. Or they didn’t have laptops. Or maybe some simply were irresponsibly thumbing their noses at the taxpayers.

All that the ballyhooed program accomplished was removing thousands of people from the Medicaid rolls of one the nation’s poorest states while placing nary a one in a job, so far as could be documented.

Medicaid exists by law to provide health services to the poor and disabled. It is not a work-training program. There are entirely separate work-training programs.

Under existing federal law, you may not—and you should not under principles of human decency—hinge health treatment for a poor person on whether he’s clicked his looking-forwork box on his laptop this month.

The Arkansas debacle got sued and overturned in federal court. The matter is now pending at the U.S. Supreme Court. But that won’t matter now that the Biden administration is telling states that it is withdrawing all effective work-requirement waivers and not issuing any more, certainly not during the pandemic.

Meantime, Arkansas’ original waiver for the original private option expires at the end of the year. The Hutchinson administration’s effort to revise it for renewal will require hard-to-get ratification from this right-wing Legislature.

The issue now for Arkansas is whether to re-up a program that fortifies the state treasury with the generous federal match, puts over 200,000 poor people into the private insurance pool to permit them health care while helping hold down all private premiums, and provides vital reimbursements to UAMS and rural hospitals.

And it is whether to do all that without the kick that red states seem to get out of requiring poor people to kowtow.

Most in the expansion population work already, just not reliably or for a living wage. They tend to work temporarily or part-time or seasonally.

Their poverty is usually not a personal failing but a predicament.

The Biden administration is telling Arkansas and other states to stop trying to use denial of health insurance as punishment for not having a reliable and better-paying job.

Indications are that Arkansas will now attempt another window-dressed finesse.

The talk is that even staunch rightwing legislators have come to accept that Medicaid expansion is here to say. But now some want to switch to basic Medicaid except for recipients agreeing to participate in some kind of “work incentive” charade, by which they could keep private insurance.

It’s all about trying to design something fair enough for Washington and punitive enough for Arkansas.