The Drake's Take

Why does Wyoming insist on punishing poor people?

Kerry Drake

Kerry Drake

— November 12, 2013

When Sen. Charles Scott (R-Casper), a leading opponent of expanding Medicaid in Wyoming, suddenly announced he would support it, his change of heart was encouraging. At the same time, I wondered if there was a catch to his reversal.

It turned out there’s a big one: Scott is willing to expand Medicaid to provide health coverage to about 18,000 low-income adults, but only if they meet his proposed state requirement to work at least 20 hours per week.

So Scott’s version turns out to not really be an expansion of Medicaid to provide services, but another excuse to shame people because they’re poor. Why can’t Wyoming be like most of the rest of the country, and not try to tack punitive measures onto a program that is designed to provide health care to some of our most vulnerable citizens? Why do we have to be so cruel before we’re willing to extend a helping hand to those who desperately need it to survive?

Medicaid was created for one reason: to provide health care coverage for low-income individuals and families, including the elderly and disabled. There are income requirements and asset limitations, but the federal program has never required participants to work, because that’s not the point. In fact, many Medicaid recipients have health conditions that prohibit them from working.

Moreover, Scott – the veteran, influential chairman of the Senate Labor, Health and Social Services Committee – should know that efforts by other states to gain a federal waiver for even less stringent work requirements have all been rejected.

In Utah last year, lawmakers sought to have recipients “give back a few hours of their time and contribute back to the community that helps fund their health care.” The state wanted a waiver so it could start a pilot program that required new Medicaid recipients to perform eight hours of community service per month to stay in the program. Marilyn Tavenner, acting administrator of the U.S. Centers for Medicare and Medicaid Services (CMS), denied the request, noting that the community service proposal “would impose an obligation on beneficiaries for access to health care coverage and services that is unrelatable to the provision” of such coverage and services.

That hasn’t deterred Gov. Tom Corbett, whose “Healthy Pennsylvania” proposal would require most unemployed Medicaid beneficiaries to be looking for work. This would impact existing recipients plus future Medicaid beneficiaries in his state. Pennsylvania’s chances to receive federal approval for its version of Medicaid expansion do not look good. In a September interview with The Morning Call of Lehigh, Pa., an expert noted Utah’s experience and other major problems.

Joan Aiker, executive director of the Center for Children and Families at Georgetown University, said flatly that any work requirement for Medicaid is illegal. “It’s unlawful to tie Medicaid eligibility to work requirements,” Aiker told the newspaper. “The federal government, not only do I think they will not grant that, they can’t.”

Corbett is banking on the federal Affordable Care Act, also known as Obamacare, to provide the means to add a work search requirement. Scott has the same hope. “The federal government is less rigid now in approving things they wouldn’t have accepted a year ago,” Scott told WyoFilereporter Ron Feemster prior to last week’s committee meeting in Lander. “The feds are desperate to get states to sign up. This is a time to do some experimenting with the Medicaid model on the federal nickel.”

It may be willing to “experiment” with some elements, perhaps, but the federal government isn’t going to change anything that will gut the fundamental reason Medicaid was created, as Scott’s proposal would.

Scott and Rep. Elaine Harvey (R-Lovell), his co-chairman on the Joint Interim Labor, Health and Social Services Committee, favor different versions of what’s become known as the Arkansas Plan. Essentially, their plans would use government funds to buy private health insurance coverage for low-income people. Scott, however, is adamant that he won’t vote for any plan that does not include his work requirement, which even Harvey said may not be approved by CMS.

People need to examine why Wyoming chose to join 27 other states in refusing to expand Medicaid under the ACA. While Gov. Matt Mead and lawmakers said we need “a Wyoming solution” to the state’s Medicaid problems, it’s clear that was a smokescreen for the real reason: conservative Republicans simply refused to approve anything that would give President Barack Obama a victory, even if it would benefit their own state. And as proposed under Obamacare, Medicaid expansion would definitely be in the best interests of Wyoming. A state Health Department study concluded that not only would it save the state $47 million over six years, declining to do so would cost Wyoming nearly $80 million over the same period.

Scott led the charge against expansion of Medicaid in Wyoming, agreeing with his party’s extreme right that the federal government cannot be trusted to keep its word to pay 100 percent of the costs of Medicaid expansion, scaled back to 90 percent starting in 2020. So it was shocking when Scott told Feemster, “We’ve got a segment of the population with a real problem. They can’t afford health insurance. They need it. And they are not eligible for insurance subsidies through the exchange. We’ve got to do something for that population.”

Poor people need health insurance, and we must help them get it? Good grief – it sounds like Charles Scott is actually beginning to understand the problem.

Alas, it was a short-lived epiphany; one that turned out to be rooted in Scott’s belief that nothing should be given to the poor unless they meet the requirements of the ruling class to show that they deserve it. It’s not enough to need health insurance – even if good health is necessary to work – the government should only provide it if you do work. Up to 20 hours a week is Scott’s magic threshold.

The legislator made the mistake of tying Medicaid expansion for poor childless adults to welfare reform’s work requirements, which he credits with getting many people off the welfare rolls. While the number of people receiving welfare did drop dramatically, many didn’t get jobs and pull themselves up by their bootstraps and are now prosperous. No, they simply dropped off the welfare caseload and continued in poverty, depending on other government programs and the kindness of strangers to survive.

“Our experience with welfare reform is that anyone who wants to can find a job,” Scott said. But for many people, working is not a choice, as Dan Neal, executive director of the Equality State Policy Center, also told Feemster.

“It sounds good to say that they have to work,” Neal said. “But they have to be able to find a job and then be well enough to get the job and keep it.” If the goal is to maximize health care for low-income people, he added, it shouldn’t be lost “in favor of some philosophical satisfaction.”

Wyoming turned down Medicaid expansion once because making a political point against the president was deemed more important than helping 18,000 low-income people. Now, Scott is willing to turn it down again if those poor people he suddenly wants to help aren’t willing to get off their butts and find a job, even if they’re sick.

Here’s the bottom line: do we want to live in a compassionate state, or do we want to live in one that punishes people just because they have the misfortune to live in poverty?

— Veteran Wyoming journalist Kerry Drake is the editor-in-chief of The Casper Citizen, a nonprofit, online community newspaper. It can be viewed at www.caspercitizen.com.

— Columns are the signed perspective of the author, and do not necessarily reflect the views of WyoFile’s staff, board of directors or its supporters. WyoFile welcomes guest columns and op-ed pieces from all points of view. If you’d like to write a guest column for WyoFile, please contact WyoFile editor-in-chief Dustin Bleizeffer at dustin@wyofile.com.

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Published on November 12, 2013

{ 10 comments }

Theresa November 18, 2013 at 11:14 am

It seems rather ironic that Sen. Scott and Governor Mead should be so adamant about finding a “Wyoming solution” to the health insurance issue. I guess some people in Wyoming still need to maintain the illusion of the proud, self-sufficient, go-it-alone, rugged individualists who populate this state but in reality, the state of Wyoming receives more federal dollars than it pays in. In that respect, we are all takers. So why are they so squeamish about accepting more federal dollars in order to help the less fortunate among our citizens.

It is also interesting to note that the Affordable Care Act is a conservative program, designed by conservatives and based on the RomneyCare model. The reason it isn’t working very well is because it really doesn’t fundamentally change the healthcare delivery system so entrenched in this country. It is still based on a for-profit system of healthcare by publicizing the risk and privatizing the profits.

Here in Wyoming with only two insurance companies competing on the exchange, there is very little incentive for the private insurers to lower their premiums. They claim that is because of our small population. However, Vermont, which has a population of a little over 600,000, is looking at implementing a single payer system in their state by 2017. They are saying that it will actually be easier to manage a single payer system precisely because of the smaller number of people participating in the program.

Maybe it is time for the people of Wyoming to work in conjunction with others in order to find solutions to this very serious problem of sick and dying people not getting the healthcare they deserve. We talk a lot about being good neighbors and pitching in and helping each other out in bad times but the sad truth is all the bake sales, spaghetti dinners, rifle raffles and money jars on the check stands at the grocery store are not going to solve this problem.

That Lone Wolf mentality isn’t helping anybody.

gwarnock November 15, 2013 at 7:19 pm

The Conservative element of our society seem to believe that anyone in need of help is a scam artist out to fleece the hard working citizens working 50 hours a week just to feed his family.
When I was growing up my father worked 50 or so hours a week, with two kids and my mother would occasionally work part time, we were able to afford a new car, a house and had enough left over to save and invest, today, with two kids and if your lucky, two parents, have to work full time and more just to survive and still may require government assistance to feed their families.
Conservative policies funnel the wealth to the top 1% with little concern for the labor that allows them their insane profit and bonuses for the CEOs.
In the past 30 years the middle class wages have actually declined 10% while the top 1% income has tripled,, and why? We are All takers of wealth from the 1%, they refuse to pay us for their profits we make possible for them!
All of our GOtP government, (state) is owned by ALEC, a right wing law writing think tank that write laws for our legislators to sign, no questions ask!
http://www.sourcewatch.org/index.php/Wyoming_ALEC_Politicians
When a right winger tells you to go find a job when you already have one, when they tell you to go to work when you are elderly or disabled, when they tell you you are lazy because there are no jobs within a hundred miles,, what do Wyomingites do? They vote for the GOtP, Watch Fokkk Lies and believe them and bitch about liberals which have nothing to do with their own problems!
Our healthcare problems are due to policies OUR State Legislators PASSED, we had the option to create our OWN healthcare, but Noo let the feds do it and then blame them for OUR failures, Wake Up People, WAKE UP!!!

LKM November 15, 2013 at 5:01 am

I would love Mr. Scott to sit down with me and listen to everyone of my symptoms caused by Ehlers Danlos Syndrome, Dysautonomia, and Neurocardiogenic Syncope, just to name the top 3 problems. I just miss qualifying for medicaid, I work as much as my body will let me and it’s NOT 20 hours a week. I’m waiting for the day that something happens at work and I’ll then file worker’s comp to cover it, that is not fair to my boss or the business he has worked hard to grow, working more hours would put me at more risk of doing this. I need help and I need it now. My health will continue to deteriorate until I become a huge burden to society. I just need a little help now to possibly avoid it. It seems I won’t get it because I can’t meet his standards. This is disgusting and I’m tired of being sick and in pain. Wake up Mr. Scott, not everyone is trying to screw you out of something. I’ve worked hard my entire life to be reduced to someone that you need to tell to go to work? Wish it was that simple.

(Editor’s note: An inappropriate sentence was cut from the original comment.)

Colleen Douglas November 14, 2013 at 11:56 pm

I think most rural living people would go to work if they could find a job within a reasonable distance that would pay a wage plus transportation cost and medical coverage.
OR, maybe the state should take all the money that they spend on welfare and Medicaid and other supplemental programs and build businesses in the rural locations and pay a good wage with medial coverage. Then people wouldn’t have to ask for help. Wyoming is so big and so sparsely populated, how can minimum wage possibly cover your living expenses, not to mention medical insurance. Rural people like Ranchers and Farmers don’t earn bureaucratic wages or benefits.

rbd November 14, 2013 at 8:54 pm

SRDT – more of the learning to fish……

Because you chose to have kids, because you choose to live in the “boonies,” because you choose to be a stay at home mom, because you chose to get a degree in counseling, you are automatically entitled to stay home and it is responsibility of society to provide you with health care and other entitlement benefits?

Don’t get me wrong, I applaud you for wanting to take good care of your kids – but herein lies the problem. If everyone takes part in the entitlement society, who is left to provide or fund the entitlements? I work hard enough providing for my family and the 15+ employees I am responsible for. As a taxpayer, why is it my burden to pay the taxes so you can draw social benefits and stay at home with your kids? Sooner or later, the scales are going to tip and not enough people will be left to pull the train and when the train stops, we lose.

Again, I applaud you putting your kids first, your family first, but not at the expense of my family or my kids. It’s great if you choose to stay at home, but you are not entitled to live off the those of us participating in the economy. That is reality.

srdt November 14, 2013 at 3:48 pm

Here is my question; the whole teaching a man to fish thing is great…. but what about the people in my shoes…. I am a well-educated woman with a master’s degree in counseling with two young children under the age of three. If I were to go to work and not stay home with my children, I would one, not only no longer qualify for the little bit of assistance that we do get but two, would be making just enough money to cover the costs of me working (i.e. child care, less time at home to make meals =equals eating out more, more money for gas to get to and from since we live in the boonies, and so on and so forth….) Sometimes working outside the home costs more than to just stay home and raise your children, take care of your family, provide nutritious meals for them, breastfeed your babies, so on and so forth. And I personally do not want to work just so that I have to pay a day care to raise my children.
Its unfortunate that my husband does not make more money and the job he does have, his hours don’t even allow him to think about getting a second job. So what do the young mothers do when you are just broke? Go out and work? I am the only one in my family without insurance, and I need it. In order for me to be covered by husbands policy would cost an extra $750 a month that we DO NOT HAVE. But we are limping by without it. Thank God, but in the mean time, people who require us to go out and just work….. are not living in reality.
How about someone real in these insurance companies that are just fiscal rapists and other factions of the medical system in this country that are experts in extortion.

cecil lena November 13, 2013 at 3:04 pm

All Republicans did not support Obamacare, all Democrats did. We are now seeing what is in the plan which was passed, per Nancy Pelosi. What is there that would make you think that increasing the Medicaid rolls would be of benefit to Wyoming?
Please provide a list of those MD’s who are seeing new Medicaid patients?
This bill “shames people because they are poor” your words not mine. Do you mean to say that they will be required to wear a “yellow star of David” to differentiate who they are from the other non-Medicaid receiving workers? How are they shamed?
Additional point, Wyoming joined a majority of states(28 v. 22) in not creating an Exchange. Can you explain why the majority of states are wrong in their judgement.
I would appreciate references to what has happened in the last 6 weeks regarding Obamacare.
Finally, often the liberal press is eager to point out that Wyoming receives more “Federal dollars” than it pays in taxes. If one accepts this I would argue that by not acceding to increasing the Medicaid rolls should warm the cockles of the liberal press in that Wyoming is not getting an additional “Federal handout.”

rbd November 13, 2013 at 6:42 am

Give a man a fish, and you feed him for a day; show him how to catch fish, and you feed him for a lifetime.

What is wrong with requiring some level of work or even be a volunteer in exchange for economic assistance? Maybe in the 20 hours of work required under this program, the individual will learn a skill or trade they can put to use and work their way out of poverty?

The liberal element in society would like you to believe that the more conservative aspect of our society is heartless and want to keep the poor in poverty. In fact, it is the opposite. We want and hope we can move people from poverty and into the workforce as self sustaining individuals in society. I believe the people in this state are more than willing to provide a helping hand to those in need – you see it everyday. Whereas the liberal element in society want to keep the poor in poverty by continuing to provide the poor benefits and entitlements and no way for the disadvantaged in our society to escape the cycle. By holding the disadvantaged in poverty, the liberal element will always have a support base for their liberal ideas and agendas via providing more and more entitlements funded by other members of societies wealth. The liberal elements power base is a foundation of society cemented in poverty.

There is no reason for any able bodied individual to be stuck in poverty in this country. While some are certainly afflicted with disabilities or health issues out of their control, many have control over their own destiny, yet choose a path of continued reliance on the government. That is why we have this social safety nets, for those than cannot take care of themselves. There are jobs…..yes, they might require you to move from Goshen County….but there are jobs, job training programs and education programs to obtain job skills. Is everybody going to make $100,000 and have a house with a three car garage? No. But there are plenty of good paying jobs waiting to be filled by motivated and hard working individuals.

There are a number of non-profit organizations that could use assistance – from basic maintenance of their facilities, answer the phone or help deliver services. Maybe the work element is just enough to get people over the hump of poverty and off government benefits.

I support staying off this fiasco called Obama Care. The liberals complain we are wasting money because we choose not to expand Medicaid. But what nobody seems to understand is that while we get 100% reimbursement today for expanding Medicaid, what will the cost be to future generations when the Fed’s only cover 90% and the State is on the hook for the 10%? What do those numbers look like? It’s the elephant in the room the liberal media choose to ignore.

Becky November 12, 2013 at 11:29 am

Where does he think all these jobs are in Wyoming? They’re certainly not in Goshen County, especially if you’re a woman. Here, there are at least 50 applicants for even a minimum wage part-time job opening. Charles Scott doesn’t have a clue how real life in Wyoming is. People want to work.

bs chaser November 12, 2013 at 10:08 am

The irony is that in small towns in WY there are no decent jobs unless you are related to someone with clout.

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