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We Must Stop Framing Programs Like Medicaid in Republican Terms if We Are to Save Them

We must view Medicaid with a progressive, not a racist eye.

Participants hold signs during the Senate Democrats' rally against Medicaid cuts in front of the US Capitol on Tuesday, June 6, 2017. (Photo: Bill Clark / CQ Roll Call)

Welcome to Interviews for Resistance. We’re now a year into the Trump administration, and activists have scored some important victories in those months. Yet there is always more to be done, and for many people, the question of where to focus and how to help remains. In this series, we talk with organizers, agitators and educators, not only about how to resist, but how to build a better world. Today’s interview is the 107th in the series. Click here for the most recent interview before this one.

Today we bring you a conversation with Rebecca Vallas, the managing director of the Poverty to Prosperity program at the Center for American Progress. Vallas discusses how the Republicans’ efforts to smear and dismantle popular programs like Medicaid as “welfare reform” are attempts to distract Americans from GOP attacks on the working and middle classes.

Sarah Jaffe: The Children’s Health Insurance Program (CHIP) was supposedly part of why the government shutdown. Give us some background on what has been going on with CHIP in the last year and how that came up to the moment that we are in right now.

Rebecca Vallas: What folks need to understand is that as much as the shutdown is the news of the moment, the discussion around the Children’s Health Insurance Program … dates back to Republicans’ failure to reauthorize the program more than 100 days ago. Last fall, Republicans were very aware … that this program was going to need to be reauthorized so that 9 million American kids could continue to get their health insurance uninterrupted.

And yet, what they decided to do was to prioritize continued efforts to repeal the Affordable Care Act and to gut Medicaid, which ate up most of 2017 for them. Then, to try to give tax giveaways to their donor class and to themselves and their rich friends and to wealthy corporations. That is obviously something they were ultimately successful in doing at the end of 2017, with Trump signing that deeply unpopular tax package that gave those huge giveaways to the wealthy and corporations at the end of the year.

People across party lines, including Trump voters, love Medicaid and don’t want to see it cut.

They decided, very clearly, whose side they were on, and that was rich people and rich corporations in this country and not 9 million American kids whose health care they threw into jeopardy. That is what brings us to present day, where Senate Leader Mitch McConnell has decided that all of a sudden, he cares about the Children’s Health Insurance Program. He has used it as a hostage that he can take to try to extract partisan political concession from Democrats. That is what we watched play out in a shutdown that Republicans have forced on the American people….

You mentioned CHIP, which is … a really popular bipartisan program that usually gets renewed with no problem through Congress and signed by whatever president is in charge. They were in the middle of trying to dismantle other popular health care programs, including Medicaid — the Medicaid expansion being the most popular part of the Affordable Care Act. People like and understand that these are programs that are good for them. I wonder if you have an idea what Republicans think they gain in trying to dismantle them.

I mentioned that 2017 was really a story of Republicans in this country trying to dismantle the nation’s health care system. They did that by repeated efforts to try to repeal the Affordable Care Act over the wishes of the American people, over the wishes of Democrats in Congress, and a big part of those efforts was an attempt to end Medicaid as we know it. That would have been by placing harsh caps on Medicaid funding that goes to the states in ways that would have meant that people would no longer be able to access Medicaid when they need it and when they qualify. Republicans really learned last year — the hard way — that cutting Medicaid is really unpopular and that people across party lines — including Trump voters — love Medicaid and don’t want to see it cut.

We are going to be watching states across the country dismantle their state Medicaid programs because of the blank check that Trump has now given them.

What we have actually seen in the course of the past several days is Trump … has learned the lesson that legislation to dismantle Medicaid is going to be very difficult and not something he is necessarily going to be able to see Republicans in Congress push forward successfully. He has decided, “I guess I am not going to wait for Congress to be able to dismantle Medicaid. I am just going to do it by fiat.”

That is exactly what we watched him do a little over a week ago. He put out an unprecedented set of guidelines that basically said, “Hey states! You are now, for the first time in the five-plus decade history of Medicaid, allowed to take away health insurance for people who can’t find a job or get enough hours at work.”

That is now what states are in the position to take him up on doing. Kentucky is the first state where we have watched this play out. Their request to take Trump on that offer was approved basically in the same moment as Trump making this announcement. Now, we are going to be watching states across the country — mostly headed by Republican governors — looking to dismantle their state Medicaid programs because of the blank check that Trump has now given them.

I want to talk for a minute about the ridiculousness of work requirements for Medicaid, because this is a program that, among other things, provides some 70 percent of the funding for home health care aides for the elderly and people with disabilities…. “Work requirements?” This is literally a program that provides health care for people who can’t work.

That is exactly right. Trump calls them “work requirements” … but [they are] really … time limits on health insurance for people who can’t find work. You can be pounding the pavement as hard as you possibly can … trying to find a job or get enough hours from your boss, but in this new world order that Trump has now thrust upon us, people who can’t, through no fault of their own, find a job, are … at risk of losing their health insurance.

Trump and Paul Ryan are trying to smear popular programs like Medicaid and nutrition and housing as “welfare” in an effort to try to make it easier to cut them.

I think it is important to actually take a look at who the people are who receive Medicaid and who are not currently working to get a sense of how this is going to play out. When you actually look at that population of folks, most people who receive Medicaid are working themselves. It has become a work support program for largely low-wage workers. Of people who aren’t currently working and who use Medicaid for their health insurance, 30 percent have caregiver obligations to kids or loved ones, 15 percent are students who are in school, 9 percent are retired, over a third report facing health problems, and then the rest are actually looking for work. Those are the supposed “freeloaders” that Trump is so worried about.

The thing that we … are deeply, deeply concerned about is that this is going to end up having devastating consequences for people who can’t end up finding enough hours at work or getting a job. They are going to end up losing their health insurance in a really, really cruel and counterproductive way that is actually going to backfire if the goal is helping people work.

This actually connects to one of my pet peeves that is happening a lot right now. Now the Republicans are on to talking about “welfare reform.” We did welfare reform. It failed. So, there is a lot of sloppiness these days in the media, allowing them to get away with talking about dismantling Medicaid as we know it, or cutting Social Security and calling it “welfare reform.”

I have to say, language really matters, and I am really glad that you are raising that particular issue. Trump and Paul Ryan, the Speaker of the House, are religious in trying to reframe and redefine popular programs like Medicaid, like nutrition assistance, like affordable housing, even school lunch as “welfare.” They know exactly what they are doing when they do that. They know that the American brain, when it hears the word “welfare,” immediately goes to a racial dog whistle sense….

Work requirements are premised on a set of myths about poverty and who is poor in this country.

They are trying to smear popular programs like Medicaid and nutrition and housing as “welfare” in an effort to try to make it easier to cut them, and to sort of do a divide-and-conquer number on the American people. Really, it is an effort to try to distract the entire population in this country who are not millionaires and billionaires from what is actually happening, which is a massive attack on the entire working class and middle class….

At their core, work requirements are premised on a set of myths about poverty and who is poor in this country. The first myth is that “the poor” are some stagnant group of people who just don’t want to work. The second is that anyone who wants a well-paying job can just snap her fingers and make one appear. Then, third, that having a job is all it takes not to be poor.

Reinforcing these myths … is core to this divide-and-conquer playbook. That is why they are using dog-whistle terms like “welfare.” They are betting that they can paint people who turn to Medicaid and other popular programs as modern day “welfare queens” so that we don’t notice what they are actually trying to do.

It is almost like this administration uses racism for everything. Your point that we assume it is a stagnant group of people is really important. This is at the heart of the way we misperceive what class is in this country. We have an idea that it is certain people who are “poor” and certain people who are “working class” — that it is not a position that can change and move.

Poverty is an experience that most of us, statistically, are actually going to experience ourselves at some point during our lives.

A lot of people learned otherwise in the 2008 crisis and the two years of recession that followed, where a lot of people who had considered themselves “working class” or even “middle class” found themselves actually poor at the loss of one job, the loss of a home. It can change very, very quickly. At a time when more and more people have discovered how quickly it can change, it is very interesting that they are still trying very hard to reiterate this stagnant idea of who is what class.

I think they know that they absolutely have to reinforce that narrative — the Fox News conception of “poverty” — that it is somebody who is sitting on a couch, lazily taking a check and eating bonbons. You watch Fox News [and] that is your sense of what poverty in [the US] looks like. They know that they need to reinforce that myth because — particularly in the wake of the economic recession of just a few years ago — more and more people are understanding that poverty is not some lifelong condition for most people. It is an experience that most of us, statistically, are actually going to experience ourselves at some point during our lives.

One statistic that I always feel the need to throw out there is almost half of Americans will experience at least one year of being poor or of teetering on the edge of financial insecurity at some point during their lives. When you actually look at what these public programs like Medicaid and nutrition assistance mean to folks, 70 percent of us are going to turn to at least one of those programs at some point in our lives….

Back to the work requirements issue and Medicaid and trying to destroy Medicaid and the ACA and all of these things. Kentucky was really an Affordable Care Act success story. It had done the Medicaid expansion, it had a really successful program, and now it wants to be the first state to institute these work requirements. Can you talk a little bit about what is happening there and how that is going to go over?

I think we know exactly how this is going to play out. I think it is really important for people to understand this as they are thinking about the Medicaid work requirements policy that now is spreading to states, with Kentucky first on that list, is that the Trump administration has said repeatedly and dishonestly that people with disabilities are going to be protected, that these new rules are not going to hurt people with disabilities. Well, guess what? They absolutely are going to hurt people with disabilities. That is something that Seema Verma, Trump’s director for [the] Centers for Medicare and Medicaid Services, has been flat-out lying in a lot of the messaging around these new rules.

Having health insurance is associated not just with better health, but also with increased work capacity which then translates into higher wages.

Let me explain why that is. The policy as Trump has released it is very clearly to apply to working-age people who are not pregnant and who don’t qualify for Medicaid on the basis of disability. It sounds pretty good when you stay at that surface level. But, if you actually understand how Medicaid works, you end up realizing that the people who qualify for Medicaid on the basis of a disability are just a small slice of people with disabilities and chronic health conditions and illnesses who rely on Medicaid for their health insurance and for critical services that allow them to live independently and in their communities and even to work.

People with disabilities absolutely are at risk, and when you read the fine print on the policy, you actually find that Verma understands that and actually says, “Hey, states! Maybe you should figure out how to administer these new rules in a way that doesn’t violate the Americans with Disabilities Act. We are not really sure how to do that, so best of luck, guys.”

The other thing I will say about how we know this is all going to play out is that we actually know from study after study after study that having health insurance is associated not just with better health, but also with increased work capacity which then translates into higher wages and earnings. What are you going to do if you take away someone’s health insurance while they are looking for work? Well, it is not going to help them find a job any faster. It is only going to make them less able to thrive in the workplace and to find a job that they can feed their family on.

It was Medicaid that saved the ACA.

That is what we are going to watch play out in Kentucky and any other states that end up having their requests to do this approved. We are going to watch people lose their health insurance in droves. It is the opposite of what the Affordable Care Act and the Medicaid expansion was trying to achieve, and it is going to end up backfiring if the goal was actually about seeing more people working.

Kentucky is an interesting state for many reasons, but it had a Democratic governor who went all in on the Affordable Care Act. It was taken over by a Republican administration this fall in the Trump wave. That was true even though the Medicaid expansion was quite popular there. I wanted to know if you had any thoughts about how we can do a better job of defending these things that are popular, and yet people will vote for politicians who are going to destroy them?

I think the first thing that we need to do is learn from 2017 — where we actually saw Medicaid’s overwhelming popularity across party lines be what stopped Republicans from being able to unilaterally repeal the Affordable Care Act and dismantle our health care system. It was Medicaid that saved the ACA. I think the lesson to learn from that is, for starters, Medicaid and nutrition assistance and affordable housing and more — all these programs that help families stay afloat when they fall on hard times or when wages aren’t enough, they are incredibly popular programs.

6.3 million Americans would be at risk of losing their Medicaid if all 50 states were to adopt this cruel new policy.

Rather than talking in the Republican … terms about these programs being for “the poor” … we need to be talking about and thinking about these programs as for all of us when we need them when our wages aren’t enough, when we lose a job through no fault of our own, when we end up needing to care for a sick loved one or when we get sick ourselves…. I think that is incredibly important to hear and to think about, because so often and for many, many years, progressive folks who have been well-intentioned in talking about these issues have really done it in terms of “protecting the least among us” or “the most vulnerable,” all of which really reinforces that myth that somehow the poor are “them” rather than “us.”

What else can people do, what are people doing now that you know of to fight this? Where are the pressure points and what kind of actions can people take?

At this point in time, where we are with specifically the Medicaid work requirements fight is that that guidance has been released from the Trump administration. Now the fight really shifts to the states where … there are live requests to put these work requirements into their Medicaid programs. Kentucky now, it is going into effect as we speak, but there are a whole range of other states. I will share this with you so you can include it on the show’s website so folks can know exactly where to be paying attention.

Governors in these states with these live waiver requests need to be hearing from people about how dismantling Medicaid is not what we want to see. This is not why we elected you and put you into office. That is going to be really important. A total of 6.3 million Americans would be at risk of losing their Medicaid under really conservative estimates, according to where our economists at the Center for American Progress have been able to estimate if all 50 states were to adopt this cruel new policy.

In just the 10 states with those live waiver requests, a whopping 640,000 Americans are at risk of losing their health insurance. It is absolutely urgent that governors be hearing from their constituents right now in this moment in time. Our partner, the Center for American Progress Action Fund, has a petition that folks can join if they want to call on Seema Verma and Trump to reverse this cruel and unpopular decision.

Then, in addition, folks should be calling their members of Congress as they have been throughout 2017 and now into 2018 to say, “Look, hands off my Medicaid, my nutrition, my education, my affordable housing.” All the things that we know that they want to cut in the name of what they are going to call “welfare reform.” People in Congress need to be hearing from their constituents that these programs are ones that we love, that we want to strengthen not cut. “Hands off” is that cry.

[The Center for American Progress] and a whole bunch of partners across the progressive community … we have all come together in a unified campaign called the Hands Off Campaign… You can share your story of what cuts to all of these kinds of programs or any of these kinds of programs would mean to you and your family. It is going to be those kinds of personal stories — putting a face on what is at risk — that is going to win the day, as it did in the health care fight….

How can people keep up with you and your work?

They can find me tweeting probably too much @RebeccaVallas. They can also follow my radio show and podcast … where I like to have people like you and other smart folks come on and talk about topics of the day and poverty and inequality.

Note: This interview has been lightly edited for length and clarity.

Interviews for Resistance is a project of Sarah Jaffe, with assistance from Laura Feuillebois and support from the Nation Institute. It is also available as a podcast on iTunes. Not to be reprinted without permission.

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