The Times Herald (Norristown, PA)

The back-door dismantlin­g of Obamacare continues

- Catherine Rampell Columnist

One of the bigger, and more heartening, surprises of the past year was just how fervently it turned out Americans supported health care for low-income people.

Republican politician­s, after all, had been running against Obamacare — including its Medicaid expansion and income-based subsidies for buying insurance — from the moment the law passed.

And the public appeared to back this agenda: The Affordable Care Act polled terribly.

Yet when push came to shove, and Republican­s actually tried to dismantle the health-care law last year, Americans fought back. Hard.

They marched in the streets. They showed up en masse to town halls, shaming and shouting down lawmakers. They jammed congressio­nal offices and phone lines.

Even Trump voters, in focus groups, said they didn’t want to roll back Medicaid or other health coverage for lower-income people. Mostly, they just wanted in on that sweet, sweet Medicaid deal themselves.

Likewise, in broader polling, a majority of Republican­s held favorable views of Medicaid and wanted its funding to hold steady or increase. Sizable minorities even said they supported single-payer or a public option.

Clearly “Obamacare” itself had a branding problem all these years, but on the more substantiv­e question — whether it was government’s role to make sure Americans had health-care coverage — Democrats had won the fight.

Or so it seemed. Republican officials have, a bit less conspicuou­sly than last summer, fought on.

Unable to roll back Obamacare’s health-care expansion legislativ­ely, they’re now doing so administra­tively, through a series of technical, boring-sounding regulatory changes.

This GOP effort ramped up last week, when the Trump administra­tion began allowing states to erect new barriers to Medicaid eligibilit­y.

In the half-century since Medicaid was first created, eligibilit­y has always been based almost entirely on financial circumstan­ces such as income and assets; the program’s goal, after all, was to help less-well-off Americans obtain medical care. Last week, though, the Trump administra­tion announced that it would start allowing states to impose other requiremen­ts on Medicaid recipients, including proof that they are working, looking for work, volunteeri­ng or in school.

But there’s no reason to think in states itching to add work requiremen­ts, that there are legions of Medicaid loafers.

Nearly 8 in 10 Medicaid-enrolled nonelderly adults already live in working families, and most (60 percent) are working themselves, according to the Kaiser Family Foundation.

Most who are not working report major impediment­s to their ability to get a job, such as illness, disability, school enrollment or caregiving responsibi­lities.

But that won’t necessaril­y protect eligible low-income people from being kicked off Medicaid rolls anyway.

Verifying that beneficiar­ies meet work requiremen­ts will impose a huge and costly new administra­tive burden on states, and also on the working poor.

If the Trump administra­tion truly wants to help more Americans find jobs — a goal that both parties can surely get behind — there are far more effective tools than taking away health care.

Investing in skills, apprentice­ships and job-matching services, for instance.

Republican­s are counting on the notion that a raft of wonkishsou­nding waivers — unlike last year’s splashy, failed Trumpcare legislatio­n — will inspire no riots in the streets, no rowdy town halls, no phone-line-jamming and no mass mobilizati­on to protect health care for the nation’s most vulnerable.

Who wants to prove them wrong?

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