After reports emerged that the Pentagon is working on plans for a “really great” military parade at the behest of President Trump, Press Secretary Sarah Huckabee Sanders released a statement explaining that the parade is meant to be “a celebration at which all Americans can show their appreciation.” I’d like to suggest an even better “really great” way to express our gratitude: Instead of rolling a bunch of 70-ton tanks down Pennsylvania Avenue (and then repaving Pennsylvania Avenue after the tanks tear it up), let’s let veterans keep their Medicaid.
You didn’t know veterans’ Medicaid coverage was at risk you say? I’m guessing you’re not alone. The Trump administration is unlikely to announce that it’s allowing those who served to be thrown off the Medicaid roles in large numbers. But when CMS issued its guidance last month permitting states to impose work requirements on Medicaid recipients, it opened that door. The state of Kentucky then walked right through it with a Medicaid redesign plan that will reverse the gains of its Medicaid expansion, hurting numerous veterans in the process.
Veterans have benefited significantly from Medicaid expansion.
In those states that expanded Medicaid, the uninsured rate for veterans has fallen significantly while veterans’ access to and utilization of healthcare has increased alongside their increased enrollment in Medicaid. That’s because many veterans, though they were impoverished and even homeless, didn’t fall into any of the categories that previously would have qualified them for Medicaid coverage. They weren’t children, or parents of Medicaid-eligible children, or pregnant women, or disabled. They were just poor and “just poor” wasn’t enough to qualify someone for Medicaid—until the expansion came along and allowed single, non-disabled adults to qualify for coverage on the basis of income alone.
In Kentucky, which expanded Medicaid under then-governor Steve Beshear, the uninsured rate among veterans went from 10.3% in 2013 to 4.2% in 2015. Health policy expert Sara Rosenbaum has called Kentucky’s Medicaid expansion “perhaps the nation’s most successful” in terms of increasing coverage and access to care, not just for veterans but for Kentuckians generally. But the waiver submitted at the direction of the current governor, Matt Bevin—and authored in part by Seema Verna, who is now the director of CMS—is, according to Rosenbaum, designed to reverse this success by “selectively culling the eligible population.”
What Medicaid expansion gave to veterans, work requirements will take away.
Those who gained coverage through Medicaid expansion, such as veterans, are at high risk of losing their coverage when work requirements are imposed. People who became newly eligible for Medicaid through the expansion are eligible based on their low income. It’s safe to assume that if they could have qualified on the basis of disability they would have had coverage already. If they aren’t considered disabled for purposes of obtaining coverage, they’re not likely to be considered disabled for purposes of qualifying for an exemption from the work requirement. But as I wrote about in a prior post, just because the government doesn’t consider a person disabled doesn’t mean they aren’t limited in their ability to work. For example, it is very difficult to prove disability on the basis of PTSD, though many people with severe PTSD encounter significant challenges in maintaining steady employment.
Veterans are also much more likely than the general population to experience homelessness, and Medicaid expansion was particularly beneficial for homeless veterans. Under the Kentucky plan, however, being homeless does not exempt a person from the work requirement. No place to live? You still have to prove you’re working to retain your Medicaid benefits, unless you can demonstrate that you are chronically homeless, usually defined as experiencing homelessness for at least a year.
Even those who are actually working are likely to experience interruptions in coverage, because the administrative burden of proving they are working is so high or because the requirements don’t account for fluctuations in work hours—think seasonal workers and those working hourly jobs in retail and food service.
So, to recap, thanks to the move by the Trump administration to allow states to undercut their own Medicaid expansions, a veteran who has spent the last six months living on the street in Louisville will be expected to meet a work requirement unless he can prove to the satisfaction of the state that his PTSD is really a disability. A veteran who is doing lawn care in Lexington might no longer be able to meet the work requirement when her hours drop during the winter. And a veteran who has been homeless for 11 months will be told he hasn’t yet been homeless for quite long enough.
Now there’s a show of gratitude for you.
Photo Credit: © Can Stock Photo / nito