Food metaphors abound in the realm of public policy—the economic pie, the Medicare doughnut hole, and of course, making sausage. So when the Centers for Medicare and Medicaid Services (CMS) recently issued a letter to states concerning Medicaid work requirements, I couldn’t help but think of another, lesser known political food analogy: the policy primeval soup, in which political actors store their desired policy solutions in search of problems while they wait for the political stars to align in their favor.
The CMS letter correctly acknowledges that health status is about more than access to healthcare, pointing specifically to education, employment and income as important social determinants of health. Unfortunately, CMS uses this fact as a convenient front to scoop up the work requirement, a misguided and overly simplistic policy idea that’s been floating around in the soup for decades, and spill it all over state Medicaid programs.
It’s obvious that this move isn’t really about improving anyone’s health, as a report released by the League this week points out, especially when viewed in the broader context of Republican proposals to decimate the federal services that have a positive impact on virtually all social determinants of health for people with low incomes.
Since we’re already on the subject of food, let’s talk about hunger, which triggers a domino effect of poor health outcomes with high social and economic costs. This year, President Donald Trump is calling for a number of devastating cuts and changes to the Supplemental Nutrition Assistance Program that would leave children, seniors and people with disabilities without enough to eat.
Despite the critical connection between housing and health, the president wants to cut safe, affordable housing programs and increase the burden on participating families. To make matters worse, by slashing the corporate tax rate, the recently enacted tax bill reduces the value of the low-income housing tax credit—a move that’s expected to discourage the construction of 250,000 affordable units, which are already in alarmingly short supply, over the next 10 years.
Regarding education, the president wants to slash billions of dollars from K-12 and funnel millions into unhealthy abstinence-only sex education programs. Furthermore, he seeks to expand the use of taxpayer-funded private school vouchers, which have been shown to largely benefit families that can already afford to send their children to private schools and enable discrimination that drives educational and health disparities.
If this were really about health, the president wouldn’t prioritize law enforcement based on the toxic ingredients of xenophobia and racism or let healthcare providers discriminate against their fellow humans in need of medical care.
Don’t be fooled: the Medicaid work requirement is merely a pretense for kicking people off Medicaid, something conservative policymakers have wanted to do for a long time. Combined with the proposed cuts to all of the other services that help struggling families maintain a basic standard of living, it will only reinforce the very economic conditions that create health disparities in the first place.
Poverty and its associated health impacts are complex problems that can’t be solved by simply requiring people to work. We need policies and budgets that actually promote living wages, job training, educational opportunity, healthy food access, healthy housing, transportation, quality child care, freedom from violence and trauma, and racial equity. If this were my favorite cooking competition show, I’d say the chef who created this disingenuous policy soup should be chopped in the appetizer round.