Why does Wyoming insist on punishing poor people?

— 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.

REPUBLISH THIS COLUMN: For details on how you can republish this column or other WyoFile content for free, click here.

If you enjoyed this post and would like to see more quality Wyoming journalism, please consider supporting WyoFile: a non-partisan, non-profit news organization dedicated to in-depth reporting on Wyoming’s people, places and policy.