Rural Whites Shielded From Medicaid Work Requirement Rules
President Lyndon Johnson signing the Civil Rights Act of 1964. The new
proposal for Medicaid work rules may violate Title 6 of the landmark labor
law, which bans race-based discrimination in federal poverty-assistance
programs. (White House Press Office)
In April, President Trump signed an executive order allowing some Medicaid
recipients to be exempted from requirements that they find jobs or lose
their health insurance. Now, the states taking advantage of the order,
called "Reducing Poverty in America," are facing scrutiny for allegedly
creating policies that, as Talking Points Memo (TMP) reports, "would in
practice shield many rural, white residents from the impact of the new
rules."
Kentucky and Ohio are applying for the waivers that the executive order
allows. Each of their proposals include exemptions for the counties with the
highest unemployment, which happen to be mostly white, GOP-voting and rural.
In contrast, according to TMP, "many low-income people of color who live in
high-unemployment urban centers would not qualify, because the wealthier
suburbs surrounding those cities pull the overall county unemployment rate
below the threshold."
Those urban areas may have unemployment rates equal to or worse than the
counties exempted from the requirements, but they're not white and they
don't vote Republican.
As Sarah Rosenbaum, a health law professor at George Washington University,
told TMP: "This is sort of a version of racial redlining where they're
identifying communities where the work requirements will be in full effect
and others where they will be left out." She continued, "When that starts to
result in racially identifiable areas, that's where the concern increases."
In addition, these waiver proposals may violate Title 6 of the Civil Rights
Act of 1964, which bans race-based discrimination in federal
poverty-assistance programs.
Kentucky's waiver, which was approved in January, will first be imposed in
northern Kentucky, which has a higher proportion of black residents than the
rest of the state.
Even before these waiver proposals, Trump's executive order was already
under fire from anti-poverty groups for placing undue burdens on Americans
who are already struggling to make ends meet, and, critics say, perhaps
over-inflating the number of people on Medicaid who don't work. As The New
York Times reported in April:
"
A 2017 study of Michigan's Medicaid program by the University of Michigan
Institute for Healthcare Policy and Innovation found that three-quarters of
those enrolled in the program were already working or physically unable to
do so. Another 12 percent were people likely to be exempt, including the
elderly and students.
In fact, "It's a little bit of a solution in search of a problem," Elaine
Waxman said of the work requirements. Waxman is a senior fellow with the
nonpartisan Urban Institute and has studied food assistance programs and
other government entitlements.
A federal court challenge to Kentucky's waiver is set to be decided in June.
