The mesmerizing farce of the Trump administration—its scandals, lurid intrigues, and flagrant lies—can easily distract us from the many ways this president and his party are making life harder for vulnerable Americans. While we all attend to the latest antics of President Twitter, his appointees and congressional allies are quietly punching holes in the safety net that protects millions of people from destitution.
One way the GOP is trying to deprive the poor of public assistance is by imposing strict work requirements on the tenants of public housing and recipients of Medicaid. In January, Seema Verma, who runs the federal Centers for Medicare and Medicaid Services, announced that the Trump administration would begin allowing states to require most non-disabled adults to work as a condition of Medicaid coverage. In late June, a few days before the first such work requirement was to take effect in Kentucky, a federal judge blocked it, ruling that the Trump administration had been “arbitrary and capricious” in approving Kentucky’s plan without making sure it was in keeping with Medicaid’s stated purpose of “furnish[ing] medical assistance” to the poor. “The record shows that 95,000 people would lose Medicaid coverage,” the judge wrote, “and yet the secretary [of Health and Human Services] paid no attention to that deprivation.” The judge was right, but he may yet be overruled by a Supreme Court too solicitous of states’ rights and too deferential to executive authority.
Administration officials argue that work requirements not only nudge people out of poverty but are consistent with Medicaid’s general goal of promoting health among low-income Americans. They point to studies showing a correlation between higher earnings and longer lifespans. But a correlation between income levels and longevity is not the same as a correlation between longevity and employment. If it were, manual laborers would have the same average life expectancy as doctors and lawyers (they don’t). More to the point, the Trump administration has the correlation backwards: the available evidence suggests not that people need a job in order to be healthy, but that they need to be healthy in order to find and keep a job. In any case, Medicaid was established with an objective much more modest and precise than encouraging healthier lifestyles; it was designed to make sure that the poor can get health care when they need it—nothing more, nothing less.