Millions Lose Medicaid Coverage in Biden’s “Unwinding”
by Emery Addams and Milena Germon
As COVID-19 spread across the globe in 2020, the U.S. federal government declared a Public Health Emergency (PHE). Working-class people were—and still are—getting sick and dying rapidly. The PHE declaration offered a bandaid measure: temporarily increasing access and eligibility for Medicaid and other government benefits.
Seemingly overnight, millions of people gained free health insurance, and additional assistance related to finances, food, and childcare. These public services were a game changer for many workers, at least for a moment. The barrier was lowered; more people had the means to support their families, see doctors, pay for medications, and eat better.
But of course, public provision of necessary goods and services during a crisis is just a temporary provision under capitalism, meant to bolster the broader capitalist system. As soon as possible, the government seeks to minimize costs and return that “market” to the private sector. In a bipartisan move, Congress “decoupled” the expansion of Medicaid from the public health emergency on December 29, 2022.
The decoupling followed a series of attacks by the ruling class to take back temporary social benefits implemented during the pandemic, leaving workers without the help they need. Now, despite proving that it is possible to provide free healthcare to millions, the ruling class—Republicans and Democrats alike—are ripping away this safety net from workers amid a looming financial crash. The PHE declaration will be revoked as of May 11, 2023, which will leave as many as 15 million workers back where they started, or worse.
Medicaid is essentially public insurance for eligible low-income individuals and families. It is regulated by the federal government but managed by states, meaning there are slight differences by state, but the broad aspects of the program remain similar across the country. The program is different from Medicare, which primarily serves the elderly and people with disabilities by providing limited types of extra healthcare coverage. Medicaid addresses an income-based gap in coverage. Both programs, as they are, use public funds to purchase insurance from private healthcare companies run with little public oversight.
Medicaid is already far from comprehensive and leaves millions of working-class families uninsured and under-insured. The yearly income limit for the program is incredibly low, far below a living wage, at 138% of the federal poverty limit, or about $20,120 per year for a single person. Many healthcare providers don’t accept Medicaid whatsoever. Many workers are faced with choosing healthcare through Medicaid over higher-paying jobs—putting them at risk of food and housing insecurity.
During the COVID public health emergency, the income cutoff for Medicaid was raised. Applications were no longer reviewed yearly but were allowed to continue indefinitely after approval. Between the lowered barriers and financial hardship many workers suffered through the pandemic, enrollment for Medicaid increased by about 30%.
Now, three years after the pandemic’s start, the capitalist class recognizes they are unable and unwilling to end the pandemic and solve the crises that stemmed from it. So instead, politicians passed bipartisan legislation to return Medicaid to its pre-pandemic state. This means that the Department of Health and Human Services (DHHS) will begin to review Medicaid applications again—specifically to remove coverage from families who “no longer qualify”.
Forms will be mailed to families asking them to provide information in a certain period of time, and if DHHS does not receive this, their healthcare will be taken away. Forms will not be received by many of the millions of families displaced by the housing crisis, some of whom will also face a language barrier.
This reactionary measure is a major threat to the working class. Not only will millions of families lose healthcare coverage or be forced onto unaffordable private insurance plans, but an incredible amount of time, money, and resources will be wasted on revoking coverage. DHHS—an already understaffed agency of underpaid, overworked, and heavily exploited workers—will have to focus nearly all of its efforts on reviewing applications. Many hospital systems and non-profits are devoting entire departments to navigating this mass loss of healthcare coverage.
This is another example of the irrational contradictions of capitalism. Society not only has the resources to provide comprehensive universal healthcare but is wasting an incredible amount of resources to defend the current for-profit healthcare system. All of this is being done to line the pockets of the capitalist class while workers suffer without insurance or cannot leave their current job for fear of losing their healthcare.
Workers do not have to accept this or any other attacks on public services and living standards. We can mobilize to fight not only for a permanent implementation of extended Medicare benefits but for functional, inclusive healthcare for all, paid for by taxing the rich, not working people. We can remove the barriers, like confusing requirements, expensive fines for not signing up ‘on time’, and cost barriers to comprehensive plans that workers face when switching from Medicaid to employer insurance or vice versa. We can reverse the attacks on trans and reproductive healthcare.
We can’t win this through the courts or by electing Democrats on their empty promises to reform the healthcare system. Instead, workers must organize, in the healthcare industry and beyond, to fight back against these attacks. Workers, especially those in DHHS who determine eligibility, should organize, refuse to unenroll anyone, and hold workplace actions such as walkouts, pickets, and strikes. Such a movement could pave the way for unions, workers, and community organizations to build a workers’ party and fight for comprehensive, free, universal healthcare.
Image Credit: Protect Our Care via Flickr // (CC BY-NC 2.0)