Dollars, cents and sadism

There is no economic rationale for shredding the safety net

Democrats want to strengthen the social safety net; Republicans want to weaken it. But why?

GOP opposition to programs helping the less fortunate, from food stamps to Medicaid, is usually framed in monetary terms. For example, Sen. Orrin Hatch, challenged about Congress’ failure to act on the Children’s Health Insurance Program, which covers nearly 9 million children and for which federal funding expired back in September, declared that “the reason CHIP’s having trouble is that we don’t have money anymore.”

But is it really about the money? No, it’s about the cruelty. Over the past few years, it has become increasingly clear that the suffering imposed by Republican opposition to safety-net programs isn’t a bug, it’s a feature. Inflicting pain is the point.

Consider three stories about health care policies.

First, there’s the saga of Medicaid expansion under the Affordable Care Act. The Supreme Court allowed states to opt out of this expansion. But accepting expansion should have been a no-brainer for every state: The federal government would initially pay the full cost, and even in the long run it would pay 90 percent, meanwhile bringing money and jobs into state economies.

Yet 18 states — all of them with Republican-controlled legislatures, governors or both — still haven’t expanded Medicaid. Why?

If it was out of enmity for Barack Obama, he’s been out of office for a year. So it’s clear that Republicans simply don’t want lower-income Americans to have access to health care and are actually willing to hurt their own states’ economies to deny them that access.

Second, there’s the issue of work requirements for Medicaid. Some states have petitioned for years for the right to force Medicaid recipients to take jobs. This week the Trump administration declared that it will allow them to do so. But what was driving this demand?

The reality is that a vast majority of adult Medicaid recipients are in families where at least one adult is working. And a vast majority of those who aren’t working have very good reasons: They’re disabled, they’re caregivers to other family members or they’re students. The population of Medicaid recipients who “ought” to be working but aren’t is very small, and the money that states could save by denying them coverage is trivial.

Oh, and of the 10 states reportedly seeking to impose work requirements, six have accepted the ACA Medicaid expansion, which means that most of the money they could save by kicking people off would be federal, not state, dollars. So what’s this about?

It’s about stigmatizing those who receive government aid, forcing them to jump through hoops to prove their neediness. Again, the pain is the point.

Finally, there’s children’s health insurance. Millions of children will lose coverage soon if federal funding isn’t restored. So what will it cost the Treasury if Congress restores funding? The answer, according to the Congressional Budget Office, is: less than nothing. A 10year extension of CHIP funding would save the government $6 billion.

A budget office analysis found that many families whose children currently are covered by CHIP could alternatively be covered by subsidized private insurance through the Obamacare exchanges. Private insurance is, however, considerably more expensive than Medicaid, which uses its bargaining power to hold down costs. As a result, subsidies for private insurance would end up costing more than the direct coverage children get through CHIP.

And remember: A significant number of children thrown off CHIP wouldn’t be able to get private coverage. The number of uninsured kids would rise substantially. Furthermore, private insurance often involves large out-ofpocket expenses and is much worse than CHIP for lower-income families.

So, Republican foot-dragging on CHIP, like opposition to Medicaid expansion and the demand for work requirements, isn’t about the money, it’s about the cruelty. Making lower-income Americans worse off has become a goal in itself for the modern GOP, a goal the party is willing to spend money on and increase deficits to achieve.

Paul Krugman is a columnist for The New York Times.