How Trump’s Medicaid Restrictions Will Stop People From Voting

The Trump administration released its fiscal year 2019 budget today, and it doubles down on what the administration has already been doing to undermine Medicaid—including more than $300 billion in cuts to the program and a call to take health insurance from those who can’t find a job.

Last month, the administration began testing these policies at the state level. On January 11th, the Centers for Medicaid and Medicare Services (CMS) announced that states can now compel low-income people who rely on Medicaid to meet “work and community engagement requirements” in order to keep their health insurance. Within a day of making this announcement, CMS approved Kentucky’s plan to implement such requirements. The plan strips Medicaid coverage from most adults who fail to comply, including those who do not complete paperwork on time or report “changes in circumstances” quickly enough.

All told, Gov. Matt Bevin’s office estimates that around 350,000 Kentucky residents will be subject to the new requirements and 95,000 will likely lose their Medicaid benefits. But once those people are booted from the program, Kentucky is giving them a chance to get it back: through “a financial or health literacy course.”

Of course, this is not the first time that Americans have been required to meet economic standards or pass a literacy test to exercise their rights. Discriminatorily applied literacy tests, known for their impossible difficulty, were administered by election officials who were given immense discretion over who to test, what to ask, and how to assess the answers when (mostly black) citizens attempted to vote. Similarly, extractive poll taxes disenfranchised poor black populations (and sometimes poor whites) from the end of the 19th century until the advent of the 24th Amendment (1964) and the Voting Rights Act (1965).

95,000 Kentucky residents will likely lose their Medicaid benefits

These methods were incredibly effective at preventing black people from voting. They led to dramatic drops in black voter registration in the South, and in the states that were the most egregious offenders—like Louisiana—black voter registration decreased by as much as 96 percent over an eight-year span.

Of course, the electoral arm of white supremacy in the postbellum era stretched well beyond such tools (and all the way to violent repression). Nevertheless, taxes and tests stand out as especially contemptible because they officially codified a logic of exclusion aimed at those presumed unworthy of American citizenship.

On the surface, Kentucky’s new Medicaid rules don’t look exactly like poll taxes or literacy tests. But there’s an equivalent logic of exclusion that holds across both domains: Those who are unworthy—either because of their race or due to their inability to access decent jobs—are ousted. Their political and social rights (like the right to vote and the right to be healthy) are sacrificed on an altar built by those with power.

Since social rights like health care are connected to political rights like voting, undermining one deteriorates the other. When Medicaid recipients are made to jump through hoops to prove that they are worthy of health care, they quickly figure out where they stand in the American social hierarchy. And once that’s clear, they have a diminished desire to participate in politics.

I know this because I spent years studying Medicaid and wrote a book about the politics surrounding it. I had in-depth conversations with people who use Medicaid; I observed  Facebook groups filled with Medicaid beneficiaries who readily recounted their experiences; I examined thousands of responses to large national surveys; and I scoured administrative records that detailed the actions that people with Medicaid took when they had scuffles with the government. I got to know some of the people who will find themselves at the losing end of the new Medicaid regulations, and I discovered how Medicaid shapes their political choices.

Take Angie, for example. Michigan’s Medicaid program stripped her coverage for not completing paperwork that she never even received. After battling for several months with local bureaucrats, she finally got her benefits restored. But by then she knew who she was in the eyes of the government:

“It’s like you are uneducated and you just want to get these free services and somehow you are inferior to other people if you receive those benefits … Once they hear Medicaid its ‘oh, one of those people.’”

Alienated from the government, Angie stopped voting and trying to advocate for herself. “I don’t do politics,” she said. When we talked about why she wouldn’t appeal devastating benefit cuts, she explained that she was a “nobody” and that the “powers that be” would not bend very far for her.

Angie was hardly alone. Ahmad fought back tears when he told me about the bureaucratic hurdles he faced after losing a limb in Iraq. Again and again he had to re-certify his enrollment, refile paperwork and find new medication when the old ones were no longer covered by Medicaid. He was clear on what this implied about his social status. “They treat us like we are stupid animals; like we don’t know anything,” he says. “I feel like I’m nothing, because when you are in Medicaid, they do whatever. You have to be on their rules.”

Just as literacy tests were applied unfairly by the election officials who administered them, adding stipulations to Medicaid will create opportunities for racial inequity. Blacks and Latinos face more labor market discrimination, have a harder time finding quality child care, and—because of biases in the justice system— are more likely to have a criminal record. In the face of such barriers, work and health literacy requirements pose burdens that will fall disproportionately on people of color.

That brings us back to where we started. Both types of literacy testing are predicated on assumptions about who deserves access to fundamental social and political rights, like health care and voting. Both also reinforce racial and economic inequality, whether purposely or inadvertently. Most crucially, both lead to the erosion of democratic citizenship among Americans whose political power has long been systematically suppressed.



Congressional Republicans Met in the Second Poorest State to Plot How to Hurt Poor People

Sammi Brown grew up in Charles Town, West Virginia. Raised in what she describes as a “barely 2-bedroom” apartment, she watched as both of her parents worked two, sometimes three jobs to put food on the table for her. “My dad worked second and third shifts so that he could walk me to the bus stop and be there when I got home,” she told TalkPoverty. “My mom worked multiple jobs … that’s kind of where I get my work ethic from.”

Brown became an organizer after seeing how challenging it was for her parents to provide basic necessities like food, housing, and health care when she was growing up. As a result, they often turned to programs like Medicaid and food assistance. “Eventually we did get off of those programs. We didn’t need them for my whole lifetime, but we were very much a working-class family,” she said.

I spoke with Brown just outside The Greenbrier, a tony luxury resort in the Allegheny Mountains, where weekend rates typically range from $358.00 to $628.00. At the time, it was playing host to nearly 300 Congressional Republican lawmakers, along with Vice President Mike Pence and President Donald Trump, who were all gathered for an annual policy retreat. Brown was one of the lead organizers for a protest—helping to bring in more than 500 activists, union members, and storytellers from across the country.


Sammi Brown

Dominating discussions this year were cuts to a wide range of health, food, and housing programs—the very programs Brown turned to as a child—all in the name of “welfare reform.” Despite resistance from Senate Republicans, House Speaker Paul Ryan and the hard-right Republican Study Committee were making a Sisyphean effort to build support for a wide range of cuts this year—starting with Medicaid.

According to reports from the retreat, it all came down to messaging. “You’ve got to get the framing or the phrasing right,” Republican Study Committee Chairman Mark Walker told Politico. “When we talk about ‘Medicaid reform,’ that’s not a great buzz phrase.” Lost on Walker was the fact that the cuts themselves are unpopular, not just the salesmanship.

It was ironic that the House and Senate Republican conferences chose this site for a conversation dedicated to slashing the safety net. West Virginia has the second lowest per capita income in the country. More citizens turn to Medicaid, Social Security, and food assistance than virtually anywhere else in the country.

Fatal drug overdoses in West Virginia dwarf every other state in the country

More than 500,000 West Virginians—nearly a third of the population—get health insurance through Medicaid, making it the state with the highest share of its population covered by the program. This includes the majority of all children in the state and more than three-fourths of nursing home residents. Congress’ proposed repeal of the Affordable Care Act, for example, would have taken away Medicaid coverage from 227,000 West Virginians by 2029—equivalent to nearly half of those currently receiving Medicaid in the state.

The state has also been ravaged by the opioid epidemic. Fatal drug overdoses in West Virginia dwarf every other state in the country. In 2016 alone, 818 people lost their lives to drug overdoses—a 400 percent increase from 2001. Nearly 9 in 10 involved at least one opioid. And, according to a report released days ahead of the retreat, drug wholesalers flooded one West Virginia town with more than 20.8 million prescription painkillers between 2008 and 2015. Nationwide, Medicaid covers about a quarter of all substance abuse treatment. But it is particularly critical in West Virginia. Medicaid covers up to 45 percent of medication-assisted treatment for opioid misuse in the state.

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Local rallies have become almost commonplace in Trump’s America. Indivisible, for example, now counts more than 5,800 local groups (at least 2 in every Congressional district), many of whom hold local actions and confront members of Congress on a regular basis. Still, it’s rare to gather so many activists from across the country in a single place. But something about the topic of this year’s retreat drew a crowd.

David Stauffer travelled from Waynesburg, Pennsylvania—a working-class town about an hour south of Pittsburgh. His grandfather, father, and uncle all worked in the coal mines in Greene County. Stauffer tried to buck the family trend by enlisting in the national guard at 18. “I wanted to serve my country … there was no other jobs in Pennsylvania other than coal mining,” Stauffer told me. “My uncle was a coal miner. He said, ‘David, you don’t want to go to the mine.’”

Stauffer served as an air technician until he injured his knee on a fishing trip and was no longer able to serve. After he was discharged, he spent years working odd jobs—at the sheriff’s department in Waynesburg, at the mine as a security guard, driving trucks. But when his brother became ill and turned to Medicaid, he needed a full-time caregiver. “My brother is in a wheelchair for the rest of his life,” Stauffer said. “He needs a caregiver. I lost my job working security.”

He travelled some 200 miles to West Virginia because he’s worried about cuts to Medicaid. “Without Medicaid, [my brother] wouldn’t be able to survive,” Stauffer said. “He can’t have a job, because he has a medicine pump in his stomach … Trump’s hurting coal mining communities. He says he’s trying to help but he’s not. He’s harming us. And it’s wrong.”

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Hector Vaca grew up in an immigrant family in New York City. “My parents had to work three jobs, each. Sometimes my dad had four jobs in order to raise four kids and just to keep a roof over our heads, continuing paying the mortgage,” he said.

“There was a time in my life when we lived on food stamps. This was before they were EBT, when they were still paper money,” said Vaca. “We’d have milk and bread in the fridge for like a day or two and we had to get creative with what we ate at the house … We couldn’t afford health insurance when we were little, so we depended on Medicaid.”

Image-1Hector Vaca

After the Great Recession hit, his father lost his job working as a car mechanic. Months later, he took his own life.

Vaca came to West Virginia because of his father’s death. “I do this … so that no other family would lose any more family members,” he told me. “We benefited from that system because we needed it, because my parents who were here with documentation worked hard and they deserved it.”

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Coverage of policy debates, like most coverage of Trump and Congress, focuses mainly on the political consequences or the legislative jockeying. Little attention is given to the people affected—the organizer from West Virginia, the caretaker from Pennsylvania, or the proud son from North Carolina. Ignored is the shear breadth of economic challenges Americans face. According to a recent survey by the Center for American Progress,* 70 percent of voters reported having at least one serious economic challenge within the past year. Forty-two percent said they had trouble paying a credit card balance, and 48 percent of Americans said they had a serious problem “finding a decent job with good wages.”

Asked why so many people were protesting, Sammi Brown’s response was simple: “We have folks that are working multiple jobs. They’re doing everything they can—and they should have quality of life, but we’re not affording them that.”

Zahra Mion contributed reporting to this article.

*TalkPoverty is a project of the Center for American Progress.



New Study Shows Free School Lunches Boost Earnings

A new study from a trio of economists proves the old adage that there’s no such thing as a free lunch. According to their research, free lunch actually has payoffs—to the tune of $11,700 more in lifetime earnings for future workers.

The study starts in the 1950s and 60s, when Sweden gradually rolled out high-quality, nutritious, free lunches to every child in its school system. Thanks to Sweden’s meticulous data collection, the authors were able to link detailed information about individual schoolchildren—including how many years they had access to free lunches—with decades of subsequent earnings, employment, and even medical data.

The economists discover that the school lunch program had tremendous positive effects, increasing adult earnings by about 0.35 percent for every year a student had access to the program, for a total of 3 percent—or $11,700 over the working years—for the average kid who was exposed throughout nine years of primary school.

The program’s positive effects were nearly universal, with large gains for the students with family incomes in the bottom 75 percent. Even the richest students derived some benefit, though it was statistically insignificant. For the lowest-income children, the gains were particularly substantial: Kids in the bottom 25th percentile of family income increased their adult earnings by nearly 5.5 percent, for an average of $21,560 more in lifetime earnings.* That means the program’s benefits were seven times larger than the cost of the meals. And, since low-income students benefitted more than students in higher income groups, the program can actually be credited with decreasing inequality.

The study adds to abundant evidence that getting enough food helps kids succeed in school—and in life—with improved school performance, greater economic self-sufficiency, and better health.

Implementing a similar program in the United States would likely have an even larger effect than the one researchers observed in Sweden. In part, that’s because more students stand to gain. School lunches in the United States are typically free only to the lowest-income students—about 20 million kids last year—and experts say they have historically been underfunded and inadequately nutritious.

The program’s benefits were seven times larger than the cost of the meals

There’s also a dramatic difference in inequality between the two countries: Swedes have a much smaller income gap between the rich and the poor, and Swedish kids are only half as likely to grow up in poverty as American kids. As the authors note, “Food shortage and hunger was uncommon in Sweden during the 1950s and 1960s.” The program’s primary goal was to improve nutrition—similar to more recent U.S. changes like the School Meals Initiative for Healthy Children in 1994—rather than addressing a nationwide problem with childhood hunger.

By contrast, in the United States about 1 in 12 families with children experienced food insecurity in 2016, and our nutrition assistance benefits for families (like SNAP, formerly known as food stamps) are so modest that they can’t address the issue. That means school meals are all the more important for low-income American kids; it’s where they get as many as half of their calories. As a result, we’d likely have an even more significant proportion of students making the types of large income gains that Sweden observed with its poorest students.

The argument against such a program, of course, would be its cost. At $3.23 per meal, extending free school lunch to every American schoolchild would cost roughly $19.6 billion per year. ** That’s about 13 percent of what Trump and Republican lawmakers just spent on their monumentally unpopular tax bill. But unlike the tax plan, research shows that this would significantly boost an average worker’s earnings—and it’d be a lot more than the temporary bump of $1.50 per paycheck Paul Ryan boasted his tax law is bringing to workers.

Next week, the stakes are about to get much higher for kids when the Trump administration releases its fiscal year 2019 budget. Trump will likely propose deep cuts to nutrition assistance; last year’s budget cut SNAP benefits by nearly 30 percent. And despite opposition from two-thirds of Americans, congressional Republican lawmakers are already chomping at the bit to help. For kids whose families struggle to put food on the dinner table, that means the cafeteria lunch line may become a lifeline.

* Calculation is based on study’s report of a total real program cost per student of $3,080 over nine years, and an estimated benefit-cost ratio of seven compared to lifetime earnings (that is, earnings between ages 21 and 65) for students in the bottom quartile of household income. Figures representing dollar-value changes in lifetime earnings are based on the study’s calculations, which use the Swedish rather than the US distribution of income and earnings.

** In 2017, an average of 20 million students in primary and secondary schools received free lunch from the National School Lunch Program (NSLP) during each non-summer month. The total federal cost of the program was just over $13.6 billion, of which approximately $10.9 billion went toward reimbursements to schools for free lunches—an average per-participant cost of about $546 for the school year. If all 35.9 million additional schoolchildren in prekindergarten through twelfth grade at schools tracked by the National Center for Education Statistics (which captures all local public school systems and most private schools) were to participate in a newly offered free lunch program to the same extent as the current 20 million participants, the additional federal costs for reimbursements to schools would be about $19.6 billion per year. However, this likely represents an overestimate because many students prefer to bring lunch from home some or all of the time, and the newly eligible students—whose families tend to have higher incomes—may have more resources to do so.



The Department of Labor Buried Evidence Showing It’s Set to Steal Billions in Workers’ Wages

Last week, President Trump’s Department of Labor (DOL) hid an internal analysis that showed that its so-called tip-pooling rule would allow employers to pocket billions in workers’ tips. They claimed that they were “unable to quantify” the rule’s effects. But we now know that they did, in fact, conduct an analysis—they just didn’t want the American public to see the result, so they buried it.

I discussed what happened and what this policy is all about with Heidi Shierholz, senior economist at the Economic Policy Institute and former chief economist at the Department of Labor under President Obama.

Rebecca Vallas: Heidi, what is this policy that the Trump administration is advancing and what are they hiding?

Heidi Shierholz: In December, the Trump administration released a proposed rule to try to make it legal for employers to take workers’ tips. There were regulations on the books from 2011—it was a long-standing practice at DOL that tips cannot be taken by employers. But the Trump administration is trying to rescind those regulations, and it’s really bad for workers.

But now the Department of Labor is bending over backwards to try to make it seem like it’s not terrible for workers. For instance, they talk about how theoretically employers who take tips could share some of those tips with the back of the house workers or other untipped workers. But there is nothing in this rule that says they are required to do so. So, what’s going to happen is employers will end up just pocketing a lot of those tips themselves.

The controversy that broke is that the DOL claimed that they could not do a quantitative analysis of how much in wages and tips would be transferred from workers to employers as a result of this rule. But what was revealed today is that that was all untrue. They actually did the analysis, and it showed billions of dollars being transferred from workers to employers. They actually took it to the Secretary of Labor who said something to the effect of, “Okay, we can’t publish something that shows this because this will make us look terrible. Take this back to the drawing board and see if you can bring me back smaller numbers.” They did that, but they never got it down as small as was comfortable for Secretary Acosta, so they just got approval from the White House to remove the analysis entirely. So this proposal was released without any quantitative economic analysis about the impact the proposed rule would have on workers, even though they are legally required to quantify the economic impact to the extent possible.

RV: So not only did they try to figure out a methodology to get a number they were comfortable with—in terms of how much employers were going to end up pocketing in the way of workers’ tips and wages—but they decided because they couldn’t get the number down they were just going to pretend they’d never done it at all? Is that what we’ve learned?

HS: Yes, that’s what we’ve learned. They said in their proposal that they were—quote—“unable to quantify how customers would respond to the proposed regulatory change” and that the department “currently lacks the data to quantify possible reallocation of tips.” So they just said in a bunch of different ways, “We can’t do this.” But we know they did do it. The numbers looked bad for them, so they buried it. This is real malpractice. The public deserves to have those numbers. They make the department look like it is not living up to its mission of actually protecting workers—in fact, it’s just going to transfer a whole bunch of money from workers to employers and they wanted to hide that fact.

They did an analysis, buried it, and then claimed that they couldn’t do it.

RV: When they went to crunch the numbers on this policy it looks like they found something similar to what you guys at the Economic Policy Institute had already been telling people for a while. You did some analysis finding that if this rule goes into effect, workers will lose billions in lost tips and wages.

HS: So we don’t know exactly what the DOL estimate was. We know it’s in the billions but no one knows the actual number. I worked at the Department of Labor. I worked on many, many analyses like this. I have full confidence that the analysis that we did at EPI likely used the same data that DOL used for their analysis. And when we did it we came up with an estimate that $5.8 billion would be shifted from workers to employers as a result of the rule and that nearly 80% of that, or $4.6 billion, would be taken from the pockets for women who work for tips, and that’s primarily because women are much more likely to work in tipped jobs.

RV: It’s not just tipped workers who are actually at risk of being hurt here, correct?

HS: One of the interesting things that’s the backdrop to this is that the DOL has been trying to sell this rule as something that will make restaurants more egalitarian, because now we’ll have this sharing between better-paid tipped workers and lower-paid back of the house workers like dishwashers and cooks. But it is very unlikely that they will do that. The rule does not require them to do it. They would be no more likely to share tips with back of the house workers than they would be to make any other choice about what to do with that shiny new revenue stream, which is what being able to confiscate tips would mean to them. They could increase executive pay. They could make capital improvements to their establishment. They could just line their own pockets. Under basic economic logic, those back of the house workers are not going to get more pay.

RV: This is hardly the first time that the Trump administration has been caught either lying or hiding evidence about the policies they’re looking to advance or the Obama-era policies they’re looking to roll back. You mentioned that because there are very specific rules governing how rule-making is supposed to happen in this country—rules that it appears that the Trump administration has clearly broken here by withholding and lying about evidence in their possession about this rule during a [public] comment period—can you explain a little bit about how that works?

HS: In this particular case, they are simply required as part of the rule-making process to quantify to the extent possible the economic impact so that the public has that information in hand in order to comment on the purposed rule.

The rule-making process in general is really basic in some sense: The agency puts out a proposed rule, anyone can comment on it. The public, advocates, business groups, anyone has the right to tell that agency what they think about their rule. The agency is actually required to read [the comments] and to take them into account as they’re crafting their final rule. So it’s absolutely crucial the public is given all the information so it can understand the impact of the rule and comment on it.

DOL claimed it wasn’t possible for them to do this quantification. But we produced an estimate in less than two weeks. It wasn’t rocket science. And now we know that they did do an analysis, buried it, and then claimed that they couldn’t do it.

Given all that has happened, they need to withdraw this rule, re-do the economic analysis, and let the public comment with all the information at hand.

This interview was conducted for Off-Kilter and aired as part of a complete episode on February 2. It was edited for length and clarity.



Paul Ryan’s Push for Workforce Development Is a Wolf in Sheep’s Clothing

Earlier today, Politico reported that House Speaker Paul Ryan (R-OH) appears to be attempting to repackage cuts to Medicaid, food assistance, and affordable housing as “workforce development.” If it were a sincere effort, the idea of offering more workforce development would make sense: It’s good for workers, and it’s actually a popular idea (Ryan himself has acknowledged that openly calling for Medicaid cuts was “not a great buzz phrase.”)  However, it seems that this is the latest rebrand of the same old proposals to slash essential benefits for struggling families that Ryan has touted for years.

It’s especially insincere, given the Trump administration’s proposal to gut existing workforce development programs. Its 2018 budget cut funding for the Workforce Innovation and Opportunity Act by 43 percent, which would cause 571,000 workers to lose job training and job search assistance. President Trump is also in the process of advancing an apprenticeship proposal that would lead to a proliferation of low-quality programs that don’t offer job-relevant skills or decent wages.

For his part, Ryan seems to be confused about what workforce development actually entails. He told his caucus last night that it needs to “focus on closing the skills gap” by training unemployed workers to take currently open jobs. This incorrectly assumes that a lack of skills is the only thing that’s keeping workers out of the labor market—it’s possible that workers are struggling to find good jobs that pay decent wages. Indeed, 2017 saw the slowest job growth since 2010, and the weakest wage growth in 4 years. Trump and congressional Republicans have also fought to make work worse by advancing policies to weaken workplace protections, make it harder for workers to collectively bargain, make it easier for employers to steal wages from tipped employees, and make it easier for employers to discriminate against workers.

If Speaker Ryan and congressional Republicans truly cared about helping people transition into the labor market, they would support policies like raising the federal minimum wage, strengthening collective bargaining rights, and advancing policies like paid leave and universal child care, which actually help improve the quality of work.

This is the latest rebrand of the same old proposals

Instead, participants at the GOP retreat where Ryan initially floated this idea reported that his proposal would impose work requirements on Medicaid recipients – of whom more than 7 in 10 are caregivers or in school. The move would put at least 6.3 million people at risk of losing their health care outright, and force others into low-quality, low-paying jobs that are more harmful than helpful.

Ultimately, this workforce development push, like welfare reform before it, is about kicking struggling workers while they’re down, and taking away essential benefits from families when they need them most. And while Ryan may have ditched the racially-coded welfare rhetoric for now, his policies are still ripped right from Trump’s divisive handbook.