OPINION

JOHN BRUMMETT: Targeted meanness

America is bitterly divided in politics by a culture war, Donald Trump, and whether and how much we should tax ourselves to take care of those who, for whatever reason, are not taking care of themselves.

The culture war is about abortion, gay rights, prayer in school, kneeling football players, and guns. The division over Trump is whether he's precisely the heroic outsider the country needs or a vile stain on our national reputation who leads us on an indecent descent.

Today we focus on the third division--whether and how to provide for those without--and on our state's emergence Tuesday in the federal vortex of that chronic and classic left-right shouting match.

This is all about Gov. Asa Hutchinson's mostly tactical and partially philosophical effort to keep Medicaid expansion alive in a disinclined and conservative-overrun state by putting a conservative brand on it. He's done that most prominently by getting the Trump administration to give the state a waiver to tie Medicaid-expansion eligibility to a requirement for recipients to take or seek work or do voluntary service and to verify as much by a series of monthly online mouse-clicked reports. Recipients lose Medicaid after three months of online inactivity.

Conservatives say work or work-seeking is the least we should require of these freeloaders reaping handouts from the responsibly employed. Liberals wonder why conservatives are so mean and resentful, begrudging a no-fault poor person health insurance.

What happened Tuesday was that three parties--the National Health Law Program, the Southern Poverty Law Center and the Legal Aid bureau based in Jonesboro--filed suit in federal court in the District of Columbia against the Trump administration's human services agencies. The suit alleges that those agencies violated the federal law that defines Medicaid's very purpose when they granted Arkansas a waiver to impose its work requirement.

Federal law declares that Medicaid exists to extend health benefits. It authorizes federal waivers for states that propose worthwhile experimental projects by which Medicaid might better achieve that objective.

The suit says the waiver for Arkansas doesn't help the state in the slightest to achieve Medicaid's statutory objective to extend health benefits. It is designed to do the opposite. The suit essentially argues that the welfare-to-work concept is one thing, but that Medicaid is, by law, health care for poor people and not properly that thing.

The political issue is that the Trump administration is systematically trying administratively to change Medicaid from a health program to a work program. It's doing that by granting onerous waivers to pliant conservative states like ours, because it couldn't possibly get a bill through Congress to change Medicaid in that way.

Just a few weeks ago, a federal judge in this D.C. district, acting on a suit by some of these same parties, blocked Kentucky's work requirement. The judge said the federal agencies granting Kentucky's waiver "never adequately considered whether [the waiver] would in fact help the state furnish medical assistance to its citizens, a central objective of Medicaid."

That would seem to apply ditto to Arkansas.

Let's face the fact: These two states are poor conservative ones that want to reap the state budgetary benefit of federal Medicaid expansion money but limit their own matching costs by reducing the number of people covered. And they want to do that by feeding this raging conservative hunger to punish poor people.

In Arkansas, Hutchinson can't very easily cut high-end income taxes next year, as he plans, without the federal Medicaid expansion manna. And he couldn't have saved Medicaid expansion in the first place without promising his right flank that he'd make those no-account poor folks work.

As I mentioned a few days ago in a column based on a brief interview with Democratic Gov. Steve Bullock of Montana, the better way to go is his state's.

In Montana, the Medicaid expansion program contains a provision that the state labor department will get in touch with all Medicaid recipients and offer them information, counsel and services on finding jobs or better ones, and training them for the opportunities.

It's not punitive, but positive. It doesn't kick anyone off the rolls; it hopes to remove people only by helping them lift their income to an ineligible level. It doesn't feed red meat, but only a lightly dressed green salad, to the ravenous conservative base.

Finally, the Arkansas political practicality: There remains some concern--from the governor's office outward--that our Legislature has not made its final peace with this program and that it might defund Arkansas Works altogether if the work requirement is struck.

I'm past worrying about that. Targeted meanness is too high a price to pay to avoid broad meanness.

Here's the solution: Accept Medicaid expansion permanently because it's good for the state. Don't break the law in the way you do it. Visit Montana.

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John Brummett, whose column appears regularly in the Arkansas Democrat-Gazette, is a member of the Arkansas Writers' Hall of Fame. Email him at [email protected]. Read his @johnbrummett Twitter feed.

Editorial on 08/16/2018

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