Yves here. The need for and extent of Medicaid is a yet another symptom of how the US medical system is profit and not patient health driven. Here in Thailand, Thai hospitals (as in with Thai speaking doctors and therefore de facto not for farangs), a doctor visit is 30 baht, or $1. The minimum wage varies by province, but is in the 337 to 400 baht a day range. And medicine here, even though having a bit of a bias to being standardized, scores well by world standards:
According to CEOWORLD’s 2021 survey of 89 countries worldwide, Thailand’s healthcare was ranked thirteen best in the world, beating out many renowned European countries like Norway, Germany and Switzerland as well as most other Asian countries except for South Korea, Taiwan, and Japan.
From the same article:
A recent report of research by John Hopkins University also ranked Thailand sixth best among 195 countries providing the strongest health security, as was reported at the Global Health Security Agenda Steering Group Meeting in November of 2019. Thailand was the only developing country ranked among the global top ten, and the first among Asian countries, scoring a total of 73.2 points out of 100.
By contrast, the US seems determined to double down on punishing the poors. As the article below points out, imposing Medicaid work requirements has done little to increase employment. The reasons include confusion about how to comply and difficult documentation requirement. It seems the point is to deny coverage and not boost workforce participation (even assuming that’s possible; consider obstacles like age discrimination).
In the meantime, there is perilous consideration of the broader public health impact of creating an underclass that gets no or very little medical care. Among other things, diseases can spread more readily in communities with a lower baseline level of health.
By Eloise Goldsmith, a staff writer at Common Dreams. Originally published at Common Dreams
As right-wing lawmakers pursue imposing conditions on Americans’ ability to access Medicaid and other social services, the Center on Budget and Policy Priorities this week published analysis warning that work requirements for Medicaid recipients could put 36 million Americans, or 44% of all Medicaid enrollees, at risk of losing their health insurance.
“Research shows that work requirements do not increase employment,” according to the authors of the CBPP report, which was published on Wednesday. The authors argue that these types of requirements are based on the premise that Medicaid enrollees do not work, when data shows that they do.
“Nearly 2 in 3 adult Medicaid enrollees aged 19-64 already work, and most of the rest would likely not be explicitly subject to the requirement based on having a disability, caring for family members, or attending school,” the report states.
The group estimates that of those 36 million people who could be impacted, 20 million are enrolled through the Affordable Care Act’s Medicaid expansion.
While almost all Medicaid enrollees either work or would qualify for an exemption under most Medicaid work requirement proposals, according to CBPP, the report points to multiple past examples that indicate many enrollees still lose coverage with the imposition of work requirements due to “administrative burden and red tape.”
For example, when Arkansas in 2018 temporarily implemented a policy that placed work requirements on Medicaid recipients, about 25% of enrollees subject to the requirements, some 18,000 people, lost coverage before a federal court paused the program seven months later.
As another example, New Hampshire implemented a short-lived Medicaid work requirement program in 2019 with more flexibility in reporting requirements and “more robust outreach efforts” in order to avoid Arkansas’ mistakes, according to CBPP, but 2 in 3 enrollees who had to comply with the requirements “were likely to be disenrolled after just two months, amid reports of widespread confusion among enrollees about how to comply with the requirements.”
The analysis—which the authors say is not an estimate of the number of people who will be impacted by a specific policy proposal—defines the population at risk of losing their coverage as adults between ages 19 and 64 who are not enrolled in Medicaid through disability pathways, i.e. a wider net of people than are specifically targeted in some recent GOP proposals.
The 36 million number is a larger group of enrollees compared to a previous CBPP estimate that was in response to a specific proposal whose work requirements would have targeted fewer people.
Multiple recent GOP proposals regarding Medicaid work requirements target “able-bodied” workers, though they vary in other specifics.
The far-right policy blueprint “Project 2025” calls for the Centers for Medicare and Medicaid Services to “clarify that states have the ability to adopt work incentives for able-bodied individuals” on Medicaid. And in late January congressional Republicans passed around a list of ideas for how to fund a bill full of GOP priorities that included imposing Medicaid work requirements for “able-bodied” adults without dependents, modeled after the Limit, Save, Grow Act, a bill passed by the House in 2023.
On Thursday, Sens. John Kennedy (R-La.) and Eric Schmitt (R-Mo.) reintroduced the Jobs and Opportunities for Medicaid Act, a bill that would require “able-bodied adults without dependents who receive Medicaid benefits to work or volunteer for at least 20 hours per week.”
Because the Kennedy and Schmitt bill includes an exemption for adults with dependents, it would impact a smaller number of people than the CBPP’s Thursday analysis. But still, as a general matter, “work requirements are simply another way to cut Medicaid,” according to the authors of the analysis. Republicans’ January list of cost cut options estimated that adding Medicaid work requirements along the lines of what was specified in the Limit, Save, Grow Act would yield $100 billion in 10-year savings.
In a Friday letter to Senate Majority Leader John Thune (R-S.D.) and House Speaker Mike Johnson (R-La.), all 47 members of the Senate Democratic Caucus wrote: “We urge you to reject proposals that use Medicaid as a piggy bank for partisan priorities and continue to defend the importance of this vital program.”
