A government that doesn’t want to help those who need it most
In the midst of a pandemic -when Americans most need health insurance, and millions can’t find work -- the Trump administration wants to kick Americans off their health insurance if they aren’t working.
Heartless, but it’s true.
This week, the Trump administration and the state of Arkansas asked the Supreme Court to allow reinstatement of Medicaid work requirements. This disastrous policy was struck down by lower courts last year after causing 18,000 low-income Arkansans to lose their insurance. Subsequent research found that 95% of residents targeted by the policy were working, or had qualified for an exemption. They were kicked off Medicaid all the same.
That’s because the program’s reporting requirements were so onerous and confusing that it was nearly impossible to prove compliance.
These efforts to erect artificial barriers to safety-net services that Americans are legally entitled to, and desperately need, are of apiece with other Trump regulatory actions.
President Donald Trump claims to favor slashing red tape and bureaucracy. He boasts about his “historic deregulation.” Yet his administration has repeatedly raised regulatory costs for disfavored groups or perceived enemies (poor people, immigrants, media companies). It has been especially active in heightening administrative burdens as a backdoor way to limit access to safetynet programs, even when Congress rejected proposals to cut these programs directly.
For example, the administration has tried, also during the pandemic, to raise work requirements for the Supplemental Nutrition Assistance Program (SNAP, aka food stamps). Another proposed rule would restrict states’ ability to make families “categorically eligible” for nutritional services based on their receipt of another government benefit; this would cause nearly 1 million schoolchildren to lose automatic eligibility for free lunches.
Many such policies have been added under the pretext of reducing waste, fraud and abuse. If genuine, this would perhaps be a worthy goal. But the (over) emphasis on compliance -- when there are relatively few errors in benefit use, and takeup rates for eligible families remain pitifully low -- appears at best misguided. At worst, it may be racially motivated, the latest iteration in the ugly myth of “welfare queens.”
Better 10 poor families go hungry, the thinking goes, than one possibly “undeserving” moocher get food stamps. But in an economy suffering double-digit unemployment, shouldn’t critical safety-net programs be accessible to all the families they’re supposed to serve?
It’s tempting to think of this as a partisan divide: Democrats prefer big government, and tend to err on the side of slashing administrative burdens to serve as many people as possible; Republicans prefer small government, so tilt toward more paperwork that will catch the cheats. But that’s not entirely right.
As Pamela Herd and Donald P. Moynihan argue in their excellent book, “Administrative Burden: Policymaking by Other Means,” conservatives want government to operate efficiently, too. Requiring reams of unnecessary or duplicative paperwork creates costs for both beneficiaries and the government agencies that process applications.
And there are good examples of Republican efforts to reduce administrative burden in order to improve program access and efficiency.
The George W. Bush administration, for example, reduced compliance costs for SNAP enrollment when officials noticed participation had plummeted. Republican-controlled Idaho had also been a leader in making Medicaid re-enrollment relatively painless -- until the Trump administration intervened.
There are also ways to streamline benefit enrollment and root out fraud without making applicants’ lives a living hell.
In Michigan, for example, the state’s previous (Republican) administration was so hyperfocused on benefit fraud it falsely accused 40,000 residents of it. When a Democratic administration took office last year, it redesigned policies and reduced paperwork requirements to make safety-net programs more accessible. But it also requested more inspector-general funding to help develop “targeted, analytically informed enforcement,” according to Robert Gordon, director of Michigan’s Department of Health and Human Services.
Although this is not a strictly partisan issue, it’s worth noting that presumptive Democratic nominee Joe Biden has proposed automatically enrolling eligible families in Medicaid based on administrative data that governments already have on file.
Voters face a choice in November: a government that wants to serve constituents during a crisis vs. one that doesn’t.