How to thwart the GOP war on Medicaid

Conservatives have come up with a new way to crush poor people with bureaucracy: work requirements for people on Medicaid!

Arkansas is leading the way, setting up new flaming hoops, and demanding that certain Medicaid enrollees jump through them to retain their coverage. As a result, over 12,000 people have lost Medicaid.

Luckily, there is a quick and easy fix for this: Simply make Medicaid like Medicare. Remove it from state control, and make it the same across the entire country — if not just part of Medicare outright. It would take away the second-largest expense in state budgets, and disallow red states from grossly harming their impoverished residents.

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In Arkansas, the new rules apply to the 280,000 people on Arkansas Works (the portion of Medicaid that was expanded under ObamaCare). The new rules, which took effect in June, require non-disabled, working-age adults (about 69,000 people) to submit a lot of complicated paperwork proving they have done at least 80 hours of "work activities" per month. If you don't meet the requirements, you lose Medicaid until the following January at least.

The motivation here is the unshakable conservative dogma that poor people are lazy, and everyone on specifically poor-only programs is a welfare cheat. Thus the conservative love for invasive (and very expensive) Big Government surveillance to make poor people do reams of complicated paperwork to prove they aren't welfare queens. But only poor people, of course. The elderly Fox News devotees collecting welfare in the form of Medicare and Social Security are noble American patriots.

Arkansas Gov. Asa Hutchinson (R) swore that he expected only "minimal" coverage losses. "This is not about punishing anyone … It's to help them to move out of poverty and up the economic ladder," he said.

Of course, catastrophe ensued.

The state issued complicated and conflicting instructions, required monthly reports through a DHS website that inexplicably shuts down at 9 p.m. every day, left phone help lines unmanned, and otherwise carried out that classic GOP governance that is equal parts malicious and incompetent. As a direct and entirely foreseeable result, over 12,000 Arkansans have so far been kicked off Medicaid (or about 17 percent of the affected population).

Likely most of them would have qualified, but found the bureaucratic labyrinth too much to manage. It's virtually certain that someone is going to die because of this policy, and probably many more than one. Victims of Republican misrule are already rationing their medication:

Catherine Rampell of The Washington Post reports another victim with chronic obstructive pulmonary disease ended up in the emergency room after these idiot rules snatched away his health insurance and thus his medication, despite being employed for the entire time.

The supposed point of a federal constitutional structure is to allow states to be "laboratories of democracy." But in this instance, the experiment is a humanitarian disaster. In the case of health care specifically, there is not much reason to do tons and tons of policy experiments. Yes, occasionally there are some encouraging ideas that aren't just kicking the poor, as has happened in Maryland. But it comes at the price of allowing Republican presidents to let Republican states brutalize their constituents. And no possible experiment would do even one-tenth as much good as simply forcing the entire country onto a rational and humane Medicaid system (which would also cut down substantially on stroke-inducing bureaucracy and red tape).

Additionally, it should be remembered that Medicaid is a giant burden on state budgets, accounting for nearly a fifth of all state spending. While the federal government picks up much of that tab (especially for the ObamaCare expansion), the cost is increasing fast, and puts a real strain on states — most of whom have balanced budget requirements. The federal government, by contrast, borrows in a currency it controls, which is also the global reserve currency, and thus has a near-limitless ability to finance social insurance programs. That is the rational place to pay for health-care programs.

So what should happen? One simple method would be to simply pick the most generous Medicaid package among all states, and replace the existing Medicaid structure with a federal version of that. An intermediate policy would be to just load everyone now on Medicaid onto existing Medicare, perhaps expand eligibility to 200 percent of the poverty line (currently 138 percent for expansion states), and throw everyone under 26 on there while we're at it.

The best solution, of course, would be an upgraded Medicare-for-all.

But this much is clear: The goofy Medicaid state-federal partnership is complicated, burdensome, and enables Republican atrocities. Let's have one health-care program for one United States of America.