Interesting, that requirement for an annnual physical. One of my loved ones, a medicaid recipient, has been waiting for months for a physical by the only doctor in her mid-sized town that accepts medicaid. Kentucky’s probably not overwhelmed by medicaid providers either. Accordingly, people may be forced off the rolls by the low level of reimbursement and the paperwork hassles that make docs understandably unwilling to participate in the program.
6
Transportation connected to finding and retaining a job was barely mentioned. Its fair to assume many Medicaid clients can't afford a car and the associated insurance coverage. The scheme put forth by penny pinching politicians is akin to planned obsolescence. The numbers will fall and the death rate will rise along with ER visits and rates of uncompensated care. Next will be turning away patients from the hospital. Good Luck, KY., you're going to need it. Where are the coal companies now when their fans need them.
4
#EconomicDarwinism :-(
3
This attitude toward lower-income members of our public is the most embarrassing thing about being an American citizen. How can a nation that brags about its Christian morality be so heartless to those in need? WWJD? He'd send y'all straight to Satan's door for being soul-less hypocrites. Same deal with Karma. If tenets from the Bible/New Testament, Buddha and other major world beliefs hold true, beware of all this selfish, egocentric behavior that (sadly) is best exemplified by the POTUS and wealthy elected officials.
6
Many will likely meet the work requirement or its exceptions but fail to deal with the paperwork needed to prove it. Kentucky knows this fact, so they are hoping to save money by dropping people who fail to prove their eligibility. It's the way Republicans govern. Vote them out in November!
5
This article is an extended illustration of the difference between imposing requirements and *helping people* to meet those requirements. Will states like Kentucky non-judgmentally *assist* Medicaid-eligible people meet the new requirements – thereby addressing the state's professed goals – or will they just let people flounder?
5
Many of these requirements seem offensive. Annual exams don’t necessarily improve health or reduce expenses. Who will compensate people for problems arising from false positives?
2
Our adult son has physical and mental health problems. He works at a local Goodwill store as much as he can. Indiana has a work requirement for those who receive Medicaid and SNAP (food stamps)--20 hours a week. He also pays a premium for Medicaid, usually $10/15 month. It is tied to his income. He also to submit paperwork every six months in order to see if he still qualifies--and that is the point of this comment. Every time we get his paperwork together , we wonder how people with fewer resources manage it. We aren't sure that our son could do it without our assistance. This not a matter of mental capacity, though sometimes phone calls are required to figure out exactly what documents are being sought. It is, as pointed out, a time-consuming matter of organization. The documents need to be mailed (transportation to post office, cost) or delivered to the local office (transportation, time).
We do see how these requirements reduce participation. But it is thanks to Medicaid that our son's health as improved. The change in his physical health reduced his absenteeism a significant amount--not because of the work requirement or the premium payment--but because he is healthier. The mental health issues are also being resolved, which will also have a positive effect on his job performance. Should he lose his benefits (which were gained only with MEdicaid expansion p, which only happened because of the ACA), his health will suffer, and then his ability to work will suffer.
I
18
Shouldn't the State of KY target employers who do not provide health insurance or full time hours for their workers? If the state has to subsidize the workers of billion dollar companies shouldn't the billion dollar companies be liable to the state? The argument about the tax breaks companies receive because they "provide jobs" is meaningless if the jobs they provide keep people in poverty.
16
More proof that our politicians are living back in the days of the Puritans. If we can't find jobs why are we being asked to pay? And why must it be so difficult to create programs that work for Americans when it comes to health and welfare when there are examples of other countries, far less wealthy than ours, that manage to do it without leaving most of their neediest behind?
America is stuck, or wallowing if you will, in the idea that no one should get anything simply by virtue of being a human being and existing. By putting a value on every little thing we have lost our own values when it comes to human life. It's more important to deny women control over their bodies than it is to provide family planning and access to birth control. It's better to let people die from both types of diabetes than it is to give them access to affordable quality care.
Americans will do anything but help themselves if it involves helping out "those people" as well. Our own bigotry is preventing us from creating a better society for all of us.
12
Thank you. I was just going to say that we're an evil bunch of people, but you said it better.
5
Health care and employment should never be tied together--it's just plain bad policy and doesn't make for a healthy population.
I'm all for healthy people getting jobs, but connecting health care with work presents lots of problems. You have to be healthy enough to hold a job in the first place.
What if you have a treatable illness but it gets worse because you can't afford a doctor? How do you then able to find/maintain employment? Employers don't like to hire sick people. It's a catch-22 situation.
Those smug people with employer-covered insurance don't understand that they are lucky. Lots of people don't have that--including those Medicaid recipients who are already working at minimum wage jobs with no health benefits included. What are they supposed to do? They can't afford to pay extra bills when they get sick. That's why they get government help in the first place.
We all pay for the uninsured, whether it's in higher insurance premiums, hospital closures, crowded emergency rooms, or health epidemics due to people who don't get treated for their illnesses and spread them to the general population.
10
Well, what can one expect of the state that spawned Mitch McConnell, the Republican behind the current government shutdown, and one of the most despicable politicians this country has ever known?
8
For Medicaid, as Margot Sanger-Katz argues, the more paper work, the fewer enrollees. Contrastingly, for Medicare, the paper work is minimal. You automatically receive a Medicare card three months before you turn 65. This year, the New York State Legislature will reconsider a bill (authored by Assemblyman Richard Gottfried) which provides improved Medicare for all New Yorkers regardless of immigration and financial status: the New York Health Act. In 2017, it passed overwhelmingly in the Assembly and was short one vote in the Senate. The bill provides preventive and specialty care, hospitalization, mental health, reproductive health, dental vision, hearing, prescription drugs and medical supplies. All financial details have been vetted by experts in the field. Paid for by a progressive payroll tax, NYHA offers savings for 98% of New York residents, eliminating the 30% currently adding to healthcare costs under private insurance. Perhaps the Upshot might report on this bill as an answer to the barriers that stand in way of healthcare as a human right.
6
If you think health care is expensive now, wait until it is free. Hmmmm...a payroll tax? That certainly sounds like a policy that will attract business and jobs to the state.
2
This makes me hypertensive. The state of Kentucky made such incredible strides to reduce the number of uninsured individuals under the Affordable Care Act, and with the stroke of a pen, much of that will be undone. The most outrageous and utterly paternalistic aspect: “Champions for the policy say the new rules will help teach low-income people how to take more responsibility for their health.” Appalling elitism to presume that someone working multiple jobs or struggling with a chronic illness (or both) doesn’t want to take responsibility for their health. If “teaching” is their goal a work-requirements policy is not the right textbook.
11
No, it's not "appalling elitism".
It's appalling *contempt*.
7
Kentucky's emergency rooms will have more and sicker patients, its poor will see increases in morbidity and mortality, and it's gross domestic product will decline not increase.
Forcing sick people to work to obtain Medicaid coverage will result in no increase in actual work, an increase in the uninsured population, and more financial stress on the healthcare system.
Many will die from delayed care. It's stupid.
But for those who found Ron Reagan's "welfare queens" gambit attractive, perhaps it will salve their desiccated soles.
6
Many low income people have insecure housing and change residences frequently, making it difficult to keep a current mailing address on file and easy to miss the endless paperwork that Medicaid sends. If a crucial form isn't submitted on time, coverage is dropped. Get the paperwork digitally? Many low-income folks can't afford a computer, internet service, or a smart phone. Try calling for help? Be prepared to be on hold for hours. Some Medicaid recipients have mental health issues, poor literacy, or other challenges that make the bureaucratic boondoggle of a government program almost insurmountable. Meanwhile, the smug, financially well off and well-insured (at taxpayer expense) politicians look for more ways to make life worse for the most vulnerable. Shame, shame, shame!
17
This is so tragic and sad. Kentucky doesn’t understand the needs and the reality of the poor and working poor in their state. Either that or they do not care. Yes, shame!
4
This is absolutely reasonable. We all work for our healthcare. Able bodied medicaid recipients should have to do the same. Liberals, as usual, have lost their minds, again.
3
If someone loses their job, they shouldn't lose their healthcare. There are many reasons an "able bodied" person might be unemployed - layoffs, lack of affordable childcare, or getting fired because they get sick. Being diagnosed with cancer, or a chronic illness that requires multiple medical appointments isn't enough to classify someone as being disabled, but is enough for many employers to fire someone. If your boss won't give you the time off for your chemotherapy treatments and fires you, then Kentucky will cancel your Medicaid so you can hurry up and die. Anyone who agrees with this hasn't just lost their mind, they've lost any semblance of humanity.
13
I should be noted that with the Trump/Republican zeal to repeal the ACA thus creating further turmoil in the insurance markets, a recently released Gallup Poll confirmed that in this first year of the Trump administration, there are now over 3 MILLION people that no longer have health insurance whom had it one year ago.
4
Kentucky Governor Matt Bevin defended his policy with the claim that he grew up in New Hampshire in poverty with "no" access to health care. Yet a city official remembers his family as middle class, his mother was an elected official, and he and at least two of his brothers attended Gould Academy in Bethel, Maine, a boarding school with 240 students and average class sizes of 10 to 12 students which currently charges an annual tuition of $58,750.
12
In Indiana, Governor Pence refused Medicaid expansion for well over a year, while thousands of the poorest Hoosiers went without insurance. (One can only guess at the number of corresponding deaths.) When his "Healthy Indiana Plan" was allowed, the only difference was that recipients had to submit a couple dollars a month, under the threat that any missed payment would result in benefits being cancelled. One can only guess how many people in need were cast aside because of a stamp falling off an envelope.
4
I pay $97/mo for Illinois Medicaid. I pay that three months at a time on my credit card. In mid-November I paid $291 for Dec-Feb. But Illinois has not yet put it in "the system" that I have paid, because they are "running behind" in updating these payments, as they told me when I called to inquire. They have my money, but I am being denied medical care and prescribed equipment, including diabetic testing strips , because I'm not "in the system".
So even those who comply with Medicaid payments may not have coverage at any given time.
6
It's just plain criminal to pay upfront and then be denied medical care because of someone else's system glitches. It makes me wonder if that's done on purpose. I wouldn't doubt it.
Kentucky and other states imposing these requirements are handing Democrats a huge political opportunity. Democratic candidates and party volunteers can send teams to rural areas to help these paperwork-challenged Medicaid participants preserve their benefits, and perhaps teach them how to use phone apps that will help them keep track of work hours and other requirements. No better way to demonstrate that Dems care more about rural poor voters than by helping them overcome GOP-imposed burdens.
6
Forget financial literacy classes -- what about literacy in general? Many of the poor who receive benefits are functionally illiterate. If they can't read the paperwork, they are at a disadvantage.
10
I have a bachelor's degree and the paperwork I have to complete for Medicaid and other assistance often confounds me.
My degree is in Social Science, and my main areas of study were poverty, and urban issues. Bit of irony, there.
5
Hell, I'm a career legal aid attorney, and I have never had a good grasp on insurance. Co-pays, co-insurance, out of pocket, and especially how it all is calculated, all of that is Greek to me.
A lot of this information should already be available to government agencies. That’s how they know whether you made a mistake on your taxes.
The United Nations Special Rapporteur on extreme poverty and human rights visited the US last year and reported that "Calls for welfare reform take place against a constant drumbeat of allegations of widespread fraud in the system. The contrast with tax reform is instructive. In that context immense faith is placed in the goodwill and altruism of the corporate beneficiaries, while with welfare reform the opposite assumptions apply. The poor are inherently lazy, dishonest, and care only about their own interests...
"But while funding for the IRS to audit wealthy taxpayers has been reduced, efforts to identify welfare fraud are being greatly intensified. The answer is nuanced governmental regulation, rather than an abdication in respect to the wealthy, and a doubling down on intrusive and punitive policies towards the poor."
Yes, as we know from looking at the White House, the rich are always trustworthy and the poor are clever people already living on easy street thanks to their generous benefits.
12
So, let's add kmore paperwork and administration, and then complain the government is too big. Gotcha. Meanwhile, punish those who are least likely to have the skills or small assets to do the required paperwork, starving needy children. Very Xian of ya!
20
If one is poor and unemployed due to being "medically frail," how is he or she to get medical documentation in order to qualIfy you for Medicaid or disability benefits? In the case of SSI/SSDI, sufficient medical documentation from one's personal doctor may require many expensive visits.
19
Kentucky should make Medicaid a lottery if the aim is just to cut out some recipients. It a least would be fairer than what they are going to do.
13
The children in chains horror house story shows what neglect does. Stunted bodies and minds. Shorting medicaid, food stamps, and education will send some children off into their future lesser persons than they might have been. A hundred year legacy and liability from our time to posterity. Worse even than the dollar debt. Federal obligations are being laid off to the states, abruptly. But even if the treasury was bankrupt and defaulting, the children are the last to throw overboard not the first just because you can. Even pre-natal mother's health and peace of mind has a hundred year effect on the future. Republicans, you better hope there is not a vengeful God.
19
Pennywise, pound foolish shortsightedness.
10
Why do you think there are so many poor young black men in jail? Many of them are victims of Clinton's welfare reform.
Why are voters putting people in office who do not represent their best interests has always piqued my curiosity. Republicans mantra is: Elect me and I will shrink government, including those programs which help people. Why in heaven's name are these people even in Congress. Never made any sense to me, never will.
DD
Manhattan
20
And without any thought as to how well or quickly the state will be able to process this additional paperwork. If the state makes a mistake, how can it be corrected? SSI recipients have to report changes in income monthly. If you're paid hourly, that means you report EVERY MONTH. They are not allowed to use average monthly earnings. If your pay changed by one dollar, you must report. Some months have 4 paydays, other have 5. Report. If a mistake is made, whether by you or by them, just try calling your local office. They do not answer the phone.
24
In an age when we are supposed to be a society that cares enough to see that all of us receive the health care that we need, we still have among us those who insist that people with no assets, often homeless & frequently missing meals, are supposed to use personal responsibility by filling out mind-numbing paperwork as a condition for receiving much needed medical care. It's irrational & inhumane to have consumer-directed, moral hazard-based policies that erect financial and other barriers to care for the four-fifths of the U.S. population with minimal resources.
Trump/ Republican policy clearly exposes the colors of these “reject Medicaid expansion” advocates. What kind of people are we that we elect individuals like this to take charge of our federal & state governments?
Denying poor people basic mental health, medical and dental care simply because they cannot fill out paperwork or pay the premium defies logic. Does sentencing poor people to receiving little or no mental health care motivate them to find time & money that they don’t have to provide them the “dignity to fill out senseless paperwork for their own health insurance”?
Needed is a nationwide, not-for-profit, one-tier system of universal, single-payer coverage, based on medical need & not ability to pay. This would end problems of failed market policies, & would resolve what Martin Luther King, Jr. once described: “Of all the forms of inequality, injustice in health care is the most shocking & inhumane.”
32
From my personal experience, when you are ill and need help also is a time when your brain is fuzzy and even little obstacles feel like mountains.
Not the time to do paperwork accurately, remember to do it, or be able to flex enough to do things out of routine.
9
How does anyone among the left think that work incentives rules in the Medicaid system is such a bad idea? I have come across stories on the internet for the last two to four years regarding how low income Americans who get Medicaid are being forced to live in houses of horrors or pushed onto the streets due to their poverty circumstances. At the same time, studies have shown that Medicaid recipients get worse health care outcomes, no dental and eye coverage for essential medical needs, many are risk from shorter life expediencies, and riddle with racial health disparities due to unequal access to healthcare. Has the semiprofessional left even bother to address those issues when ACA was signed into law by President Obama in 2010? No. They want you to believe that social welfare programs like Medicaid is some Disneyland fantasy for the poor while failing to see the realities that public welfare schemes are really preventing poor people to get them out of poverty due to bureaucratic waste and incompetence. Other countries that have generous healthcare coverage access than the US do have some type of work incentives for their own citizens. Needless to say, its about time that work requirements in Medicaid are long overdue if the growing indigent population is being pushed into extreme social marginalization and exploitative abuse due to a lack of federal civil rights enforcement.
1
I'm on Medicaid and it is great. I keep better control of my diabetes than when on regular health insurance because my doctor's visits and co-pays don't eat up a tenth of my monthly income. I would love for it to cover dental and vision, and we should push for that expansion. I do note that even when we had regular insurance, dental and vision were extra and not included. At any rate, my family is more secure and our long-term health will be better for our access to Medicaid. It's such a relief to have it. I wish everyone could have access to it. We and others are less likely to have housing problems because medical care is free. Now, we do live in Washington State and I wouldn't be on Medicaid if they hadn't told me I was eligble as the article mentions they do.
Are you aware that Medicaid is far less wasteful than the for-profit insurance industries? More of each dollar spent goes to actual health care rather than administration.
I do not see how Medicaid is pushing people into being marginalized or economic abuse. I really don't see any logical pathway for that to happen.
10
"Public welfare schemes are really preventing poor people to get them out of poverty due to bureaucratic waste and incompetence."
But the work requirement increases the amount of bureaucratic paper shuffling in Medicaid! Money that could have been spent on medical bills or looking for real fraud in the Medicaid spending will now be used to pay a fleet of bureaucrats to check to make sure that the work requirements are being satisfied.
1
I’m not sure where you live or from where you state Medicaid participants get insufficient medical care. In my city and my state, the medical care is equal for all. I saw it first hand in the health field. I support working, but in this case working for an even insufficient salary can cause one to lose the health care benefits.
I was a full time high school teacher for over a decade when I decided to go back and finally finish my PhD in my mid 30s. Now I am employed part time in education while I finish up my dissertation in the next year. Had it not been for a bronze plan with my state health care exchange and extra financial support from my parents, I would most likely be looking at disaster plans or Medicaid. During this phase of my life, I have seen what it is like to budget month to month and try to do everything possible to stay healthy, yet productive. While I will eventually return to full time employment with benefits and a regular salary, I understand what it is like to struggle financially. Mine was optional, but I really have compassion and empathy for people who may be underemployed and struggling to find healthcare coverage. Foes of social welfare program always talk about "freeloaders" who take advantage of the system, but I can tell you that is not usually the case. If you do not count the elderly, children, or disabled, who make up the bulk of Medicaid recipients, most others are people who find themselves in transition.
36
In kentucky our State retirement and Teacher retirement systems will collapse for lack of funding. Now our governor and Republican legislature plan to generate revenue by removing people from medicaid rolls, not by making them healthier, but by making it more difficult to get health care. One third of our people are on medicaid or medicare. In Kentucky we value our money. Our legislature , our Governor would not spend a dime to watch a piss ant eat a bale of hay.
8
Sounds like a death panel to me!
20
Exactly!
For pete's sake STOP BEING SO PATRONIZING!
Everyone has to do a "list" to function in the US
(1) Car insurance renewals every 6 months. Lower income households in particular pay car insurance on a monthly payments.
If the "poor" can pay their car insurance, they can pay the Medicaid nominal premium
They also have to manage to pay the rent/mortgage, electric, gas & water bill every month.
(2) They can manage to collect unemployment which requires detailed reporting of their efforts to find work - where they applied etc. Most states require this to be submitted WEEKLY!
They can manage to report their income for Medicaid
(3) Don't renew & get kicked out for 6 months? Oh well works the same when picking employer health insurance except there the employee is outta luck for 1 year.
(4) They can do this stuff on their phone. This is a small village except during tourist season. You know who is on food stamps. Medicaid etc because they talk about & have their Food Stamp card at the grocery store. And yes they all seem to have phones as they text away & check Facebook. A used smartphone & data plan is the same or less than a house phone & internet.
Or they can always go to the library where they have to go to report to unemployment on line.
(5) Oh wahhhhh those claiming to be too ill to work need medical evidence. Well they better have such evidence as they try to get disability!
2
The poor often can't pay for any of those things. But I guess that's their problem. If they're poor they must be inferior and deserve their poverty.
9
If you're so perfect, how come you live in Michigan?
12
The issue isn't that it's impossible for anyone to meet the requirements. The issue is that a minimum wage worker without employer coverage who enrolls in Medicaid could be acting in good faith yet fall short on some new administrative procedure and find themselves locked out of the program for 6 months. For example, someone who gets the flu and misses some work might not remember to submit a note from their doctor to explain why they fell short on the 80 hours of work requirement one month. And other examples.
29
Kentucky and the other states don't have the jobs needed to make up the difference. The reason able bodied people are on Medicaid in the first place is that the jobs available aren't ones they can do for various reasons. The state leaders don't care about the people really. All they are poor and can't fund the coffers of the re-election campaigns!
The Good Christian leaders aren't good or Christ like enough to get that title either if they are the ones pushing the poor back down into the dirt, saying fend for yourselves.
13
This is what happens when representatives have no opposition for their job. Gerry-Mandering and Citizen United have created safe havens for abusive governance. It doesn't take many of them to form a bloc that basically cripples any attempt at good, compassionate, sensible governance.
13
Of course these changes will make fewer eligible people apply for Medicaid. That is the point!
14
But the taxpayers will end up having to pay more in the long run. When people around your are sicker and have less access to health care, it will eventually cause everyone else to be sicker and poorer.
It is not an economically sound policy. The administrative costs could be used for health care instead of wasteful paper work. Fewer people with access to health care means more hospital bills at public expense down the road spreading critical care thinner and making it more expensive.
Any way you look at it, it is poor planning and poor public policy. It's that some people feel better when there is a war on the poor and fragile. It would be more honest just to say you want them to die faster to save the government money. Better yet, just round them up and put them in poor houses or work houses like the did in Victorian England. It's that wealth gap at work again. It's what happens when the uber rich decide there are just too many poor people mucking up the roads and byways that you have to step over.
4
or people will work and maybe qualify for employer based care. It will cost less in the long run, not more
It would be interesting to track the health and mortality of the affected parties in this inhumane experiment.
And we should all question our collective moral conscience on how justifiable is it to deny people essential services to maintain life and health all because of money, which is basically a "mutually shared illusion" as The Onion so satirically defined years ago. We are hand-wringing ourselves and letting people die or sending them off to die all because of money, especially the prevailing type, fiat money.
9
...and as eligible people drop off the rolls, the state's governor will proudly declare his program a success and put it up on a pedestal for other states to emulate.
Meanwhile, the state will not publish factual statistics on:
--the number of eligible dis-enrolled,
--the increase in emergency room utilization by those eligible thereby straining public taxes, nor
--the number of those that fail and the negative outcomes in their lives.
It will be lying by omission - lying in such a way that locals will believe the program's premises and start to victimize Medicaid recipients, not to mention to vote for similar programs when they appear on ballots.
This is wholesale cruelty soon to be on a national basis.
22
Not to mention the damage done to hospitals who will have to eat the bills for the uninsured rather than getting reimbursed by Medicaid. It's made a huge difference for many hospitals, particularly rural ones, and my impression is that a lot of Kentucky is rural.
8
Some people might just be unemployed or underemployed, but Medicaid supports the sick and handicapped. My brother has been handicapped all of his life. Some of his supports require monthly certification.
It's not just a hassle to get the paperwork for him, but the bureaucracy processing it has to take time to determine that this month is the same as every other month in the last 59 and a half years.
In the meantime, while processing all that paper, the bureaucracy is not spending time reviewing questionable cases. As a result, the people who truly need Medicaid are at risk of losing it and the cheaters get a pass.
14
Kentucky has elected two senators, both republican and against Obamacare. They elected a republican governor who ran on a platform of taking away healthcare. None of this should come as a surprise.
18
The poor are not like your and me. They don't have all their paperwork neatly filed where they can put their hands on it. Their incomes fluctuate almost monthly, which can affect eligibility. They don't have reliable transportation or work hours. Getting through each day is a challenge, logistically and financially. Planning ahead is a luxury. This is not an indictment, it's just reality. Think they get a free ride? Try that ride for a month and see how you like it - and how hard it is to escape it.
29
How do more rules and paperwork teach anyone, poor, middle-class or rich, to take more responsibility for their health? If I had to jump through so many hoops to maintain my employer-sponsored insurance, I'd probably give up too.
25
It does teach them to hate the government....
3
Of course, it saves money, however, it lacks compassion and in the long run, costs the state more money in the future.
17
It reminds me of technology in general today, computers in particular.
Companies make it so difficult to operate, maintain, update computers that it becomes a real burden for people ages 35-60 and nearly impossible for seniors.
6
As this column focuses on how or when several states, as examples, make it harder for Medicaid enrollees to maintain their coverage, or eligibility, as you prefer, there is the clear instance that states used making requirements more difficult would reduce their costs in the program.
It is not complicated how Medicaid is funded but is is also not simple. Until the end of President Obama's administration there were clear guidelines for Federal and state participation in sharing the costs. As of the current administration, it is accurate to observe that little other than less of the minimum needed to keep up Health care under Medicaid, the Affordable Care Act (ACA) or CHIP has been parceled out.
Among the decisions that some State governors chose under the ACA was not to expand Medicaid. That choice resulted in fewer persons being covered for health care and consequent failure to provide or help to provide for those needing Medicaid. These states just didn't believe health care costs were anything but an individual's responsibility.
Similarly, options for CHIP resulted in certain states running out of money before the program expired.
States want to reduce costs but the administration of increasing requirements is not cheap. The poor do not see much change in their lives. Helping them to be well is less costly than helping them to move away or die.
16