Kevin McCarthy & House Republicans finally crap out their "Dance, Spider, Dance!" Act, risking healthcare coverage for millions of Americans

This just in, via CBS News:

The House on Wednesday passed a bill that would raise the debt ceiling and slash trillions of dollars in government spending, delivering House Speaker Kevin McCarthy a victory in his efforts to pressure the White House to begin negotiations ahead of a fast-approaching deadline to avoid a default.

The House voted 217 to 215 to pass the Limit, Save, Grow Act of 2023, with all but four Republican members voting in favor. The Republicans who voted against the bill were Reps. Ken Buck of Colorado, Andy Biggs of Arizona, Tim Burchett of Tennessee and Matt Gaetz of Florida. No Democrats supported its passage.

The measure would lift the debt ceiling by $1.5 trillion or until the end of March 2024, whichever comes first, and cut spending to the tune of $4.5 trillion.

Those cuts mean it's dead on arrival in the Democratic-controlled Senate and President Biden has vowed to veto it.

Over at Vox, Dylan Scott notes that in addition to draconian cuts to dozens of vital services for millions of Americans, the GOP bill would put up to 21 million Americans at risk of losing Medicaid coverage via one provision alone:

As many as 21 million Americans could be at risk of losing their Medicaid coverage under the House GOP’s work requirement proposal, according to a new Biden administration analysis shared exclusively with Vox.

The projections are both a warning about the potential consequences of the strict reporting requirements Republicans are contemplating and ammunition for Democrats in the upcoming negotiations over raising the federal debt limit.

The House’s work requirement proposal — dubbed a “community engagement” requirement in the bill’s text — would mandate that many Medicaid recipients work, look for work, or participate in another kind of community service for at least 20 hours per week (though some conservatives want that number to be even higher).

According to Punchbowl News, these work requirements for social programs are, along with spending cuts and permitting reform, a top priority for the House GOP in talks over raising the federal debt ceiling.

Children under the age of 18, adults over 56, people on Medicaid with mental or physical disabilities, and parents of dependent children would largely be exempted. However, that exemption is not ironclad.

For one, states would have the ability to subject more people, such as parents, to the requirement, based on the Georgetown Center for Children and Families’s read of the bill’s text. Second, people with disabilities could still be required to submit information to receive an exemption — which raises the possibility that a snag in their paperwork could lead to them losing benefits.

In their new projections, the Biden administration estimated the number of Medicaid recipients who would be required to meet the work requirement or submit information to prove they should be exempted. Those are primarily people living in 40 states that have expanded Medicaid through the Affordable Care Act. Most of the expansion population is childless non-disabled adults, but some parents and some people with disabilities could also be subject to the reporting requirements depending on the state in which they live and their specific circumstances.

While the 21 million estimate may be an outlier, other analyses still come in at eight figures, such as this one from the Center on Budget & Policy Priorities:

A Republican proposal led by House Speaker Kevin McCarthy would take Medicaid coverage away from people who do not meet new work-reporting requirements.[1] The McCarthy proposal would apply to all states, but in practice it would heavily impact people covered by the Affordable Care Act (ACA) Medicaid expansion. Of this group, more than 10 million people in Medicaid expansion states would be at significant risk of losing coverage under the McCarthy proposal. This group would be subject to the new Medicaid requirement, and they are not part of a group that states could readily identify in existing data sources and exclude from burdensome reporting. The McCarthy proposal could jeopardize coverage for millions more, by prompting some states to drop the ACA Medicaid expansion or dissuading states that have not yet taken the expansion from adopting it.

"Nationwide, we estimate that over 10 million Medicaid expansion enrollees — more than 1 in 5 of all Medicaid enrollees in expansion states — would be at risk of losing Medicaid coverage under the policy in McCarthy’s debt limit bill, using 2019 (pre-pandemic) data."

The analysis by the Georgetown Center for Children & Family's analysis concludes:

If enacted, this new complex and punitive administrative structure would be imposed on states by the federal government in the midst of an already massive Medicaid administrative undertaking to “unwind” the continuous coverage protections in place during the COVID-19 public health emergency, which is just kicking off now. So states would be mandated to create a complex set of new bureaucratic requirements and apply them to everyone in their Medicaid program. Mistakes will happen and people will fall through the cracks.

The Speaker’s bill has it backwards – having Medicaid actually support people’s ability to work when they can get their health conditions addressed. Taking it away will only make it harder for them to work. Low wage workers who are working in temporary, part time or seasonal employment, or in sectors like landscaping and hospitality, are rarely offered affordable, comprehensive health coverage by their employers. So they need Medicaid to be able to work.

One thing is for sure– if this provision were to be enacted, people will lose their health insurance and any so-called savings accrued from this proposal will result from just that.

We've seen this movie before, of course. As Joan McCarter of Daily Kos put it in 2015:

Most of these people are already working, assholes. How about instead of trying to embarrass them further for being poor, you work on embarrassing their employers for refusing to provide them health insurance or refusing to pay enough that they can buy it with Obamacare subsidies? And why isn't the fact that most people who would qualify for Medicaid who are now in the gap are working the beginning point in any discussion about Medicaid expansion and work requirements?

To Politico's credit, they do report (about 15 paragraphs in) that the majority of these people work, and add that among "those who don’t work, about a third said they were taking care of a home or family member, 20 percent were looking for work, and 17 percent were mentally ill or disabled." They point out that those numbers are close to the national labor force participation rate. There's a reason why this population is called the "working poor." Because they are working!

In March 2021, the Kaiser Family Foundation posted updated findings on this issue, concluding that out of nonelderly Medicaid-covered adults (age 19 - 64) who don't qualify as being disabled under Social Security Income parameters and who aren't also enrolled in Medicare:

• 43% work full-time
• 18% work part-time
• 13% are at-home caregivers
• 11% were unable to work due to illness or a disability which didn't fit the official SSI definition
• 6% attend school, and
• 9% were retired, unable to find work or other.

Are there some Medicaid enrollees who are lazy bums, lying around on their couches eating bonbons while soaking up that sweet, sweet free healthcare coverage? I mean, probably; any population of ~23 million or more is bound to have a small number of shiftless layabouts, or whatever the term du jour is. But it's a pretty tiny percent; certainly not enough to justify making millions of others jump through bureaucratic hoops just to "prove" that they're worthy.

As I said 8 years ago, the "get off your ass and work!" requirements appear to be nearly as big a waste of time and resources as the infamous "drug testing for welfare recipients" bandwagon which a bunch of states jumped on board with a decade or so ago.

As for the "kicking them off Medicaid will force 'em to work" talking point, that was roundly debunked years ago as well:

The first major study on the nation’s first Medicaid work requirements finds that people fell off of the Medicaid rolls but didn’t seem to find more work.

Since Arkansas implemented the nation’s first Medicaid work requirements last year, a new study published in the New England Journal of Medicine has found, Medicaid enrollment has fallen for working-age adults, the uninsured rate has been rising, and there has been little discernible effect on employment.

The research appears to confirm some of the warnings from Medicaid advocates who opposed the Trump administration’s approval of work requirements in Arkansas and other states. People are losing Medicaid coverage, often as a result of confusion rather than failure to meet the work requirements, but they aren’t finding jobs and getting insurance that way. They are simply becoming uninsured.

Put quite simply by Adam Serwer, The Cruelty Is The Point. The philosophy here is to make dance to avoid getting shot.