Medicaid scheme’s ill intent

The Trump administration wants Medicaid beneficiaries to prove they are working or participating in “community engagement activities,” which like most such barriers is designed to jettison people from the program. However, because the administration is legally bound to justify the change as furthering the goals of the low-income medical insurance program, Medicaid’s top bureaucrat, Seema Verma, has argued that the requirement will improve health, based on evidence that richer people tend to be healthier.

That is, in a classic piece of Trumpian illogic, the administration is proposing to make Americans healthier by taking away their health coverage.

This latest volley in President Trump’s callous war on his predecessor’s Affordable Care Act, which expanded Medicaid, invites states to seek federal waivers from program rules that will allow them to require proof of employment. Ten states, including Arizona and Utah, have pending applications to do so.

Most Medicaid recipients are children, seniors or people with disabilities who would be exempt from work requirements. Of the rest, according to a Kaiser Family Foundation analysis, about 60 percent work and 80 percent are in working households.

The trouble with Verma’s argument is that it invents a simple, causal relationship based on a correlation that may well suggest good health promotes employment, not vice versa. Indeed, the evidence shows that Medicaid has made people healthier and no less industrious; hence its long history, until now, of broad, bipartisan support.