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Very Clever Politicians Are Using Paperwork to Stop American Children From Going to the Doctor

Charles P. Pierce
Photo credit: The Washington Post - Getty Images

From Esquire

This is certainly the way things should work in an advanced democracy. From The New York Times:

The baby’s lips were turning blue from lack of oxygen in the blood when his mother, Kristin Johnson, rushed him to an emergency room here last month. Only after he was admitted to intensive care with a respiratory virus did Ms. Johnson learn that he had been dropped from Medicaid coverage. The 9-month-old, Elijah, had joined a growing number of children around the country with no health insurance, a trend that new Census Bureau data suggests is most pronounced in Texas and a handful of other states. Two of Elijah’s older siblings lost Medicaid coverage two years ago for reasons Ms. Johnson never understood, and she got so stymied trying to prove their eligibility that she gave up.

You know what's one of the big problems facing the poor in America?

The paperwork.

Some state and federal officials have portrayed the drop — 3 percent of enrolled children — as a success story, arguing that more Americans are getting coverage from employers in an improving economy. But there is growing evidence that administrative changes aimed at fighting fraud and waste — and rising fears of deportation in immigrant communities — are pushing large numbers of children out of the programs, and that many of them are now going without coverage. The declines are concentrated in a minority of states; in other places, public coverage has actually increased.

This is the same trick that the Clinton Administration—to its everlasting shame—pulled with the SSI program during its welfare-reform heyday. Make the bureaucracy so daunting, inject just enough Kafka into the proceedings, that already overburdened and exhausted people just forget to dot an I or cross a T, and then they fall off the lists and you can claim a victory for the taxpayers. It's been a general strategy toward the social safety net among Republicans for decades.

Some of the states that saw the largest increases in uninsured children — like Tennessee and Texas — were those that created rules to check the eligibility of families more frequently or that reset their lists with new computer systems. In some states with large immigrant populations like Florida, doctors and patient advocates report growing concern among parents that signing up their children (who are citizens) may hurt their own chances of getting a green card or increase their risk of deportation.

You just know that, in these states, there was a meeting of a roomful of sleek young politicians on the make who congratulated themselves on the cleverness of their strategy.

Other states have also begun checking family incomes more often, or removing families who may have moved if mail is returned to the state. “The way they are doing this seems clearly designed to throw people off this program,” said Eliot Fishman, a senior director at the consumer group Families USA, who was a top Medicaid official in the Obama administration. When Tennessee updated its enrollment computer system in 2016, it generated thousands of errors. Medicaid and CHIP enrollment in the state has declined by more than 55,000 children since January 2018, according to the Georgetown Center for Children and Families.

Advanced democracy, my elbow.

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