OPINION

BRUMMETT ONLINE: Still mean on Medicaid

The practice might turn out not to be widely harmful. But the policy remains broadly mean.

And any human harm caused by a broadly mean public policy is shameful on those who make and support the policy.

Arkansas just threw nearly 4,000 more people off Medicaid expansion because, for three months consecutively, they failed to go online and register user identifications and passwords to click around to report that they’d been working or doing volunteer work.

We’re now north of 12,000 cases in seizing government health insurance from people who had the aid because they were poor.

The purge is from the nation’s first Medicaid work requirement, one under pending federal lawsuit and that Gov. Asa Hutchinson explained candidly in a campaign debate last month.

He said that, if we don’t impose this work requirement (in reality a computer-click requirement), then Republican legislators won’t vote to fund the program for the 250,000 others who have exemptions or are disabled or who manage to get computers clicked dutifully to say they’re working or volunteering 80 hours a month.

Insisting on kicking around 12,000 people before you’ll help 250,000, and kicking around all 250,000 if you can’t kick around the 12,000—mean, as a word, fails to suffice.

But Hutchinson said in a televised interview with Talk Business and Politics the other day—essentially, by my unvarnished paraphrase — that the practice based on the policy may not be so awful.

He said he’s so worried about these purged people that he’s having state officials look hard for them. He said any wrongfully purged may reapply imminently after the first of the year.

He further signaled his worry by saying he’d had people call hospitals to see if they’d seen a spike in uninsured poor sick people whose charges the hospitals were forced to eat. He said they weren’t finding any.

All he can conclude from that, the governor said, is that these 12,000 or so have found work pulling them out of Medicaid eligibility, or have moved to other states, or just don’t give a hoot.

There are databases that answer some of those questions. Persons on Arkansas Works who go to prison—you can find that information and kick those people off Medicaid. Persons who moved to other states and went on public assistance—ditto. Persons going on payrolls getting remunerated at a level making them Medicaid-ineligible—there are public records on that.

Hutchinson also has said the work requirement helps provide a vital ongoing inventory of the Arkansas Works population. It would be one thing, he explains, if the state was providing these people with straight Medicaid paying their bills if they showed up at the hospital. But under Arkansas Works, the innovation formerly called the private option, the state is paying private premiums for them every month. The governor contends—and he’s right—that we shouldn’t be paying premiums for people who have fallen off the face of the earth.

But you needn’t phony up a computer-click work requirement to do an inventory.

And for the vast majority of monthly purges, the governor simply assumes.

It’s that reliance on assumption that has caused a federal advisory commission to ask the Trump administration to pause the state’s work requirement at least until the state can credibly demonstrate a better command of who is getting purged and why.

The Trump administration is not going to pause diddly. The Trump administration exists for meanness, and little Arkansas is its first attack-trained pit bull.

Meanwhile, the lawyers bringing the lawsuit against the work requirement in a District of Columbia federal court have found and named … not assumptions, but plaintiffs, real people with real stories of losing their health insurance because, for one reason or another, they couldn’t negotiate what they found to be a user-unfriendly process.

This program will be stopped early next spring, most likely. The D.C. federal judge will rule as he ruled in a similar Kentucky case—that, by a federal law that Republicans tried to change but couldn’t, Medicaid is defined as a federal-state partnership existing for the purpose of expanding health care, and that throwing people off on a work requirement simply violates the law.

Work encouragement and worker training should be separate positive programs, not punitive health insurance hammers.

If such a ruling comes before our state Legislature votes on the appropriation authorizing Arkansas Works, then we’ll find out if our legislators are as mean as the governor seems to think.

Meantime, more states are moving into Medicaid expansion. Some are even trying to train recipients for work, not punish them for failing to aim that little mouse thingy up to that little portal thingy.

John Brummett, whose column appears regularly in the Arkansas Democrat-Gazette, is a member of the Arkansas Writers’ Hall of Fame. Email him at jbrummett@arkansasonline.com. Read his @johnbrummett Twitter feed.

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