Kalena Thomhave

Kalena Thomhave is a writing fellow at the Prospect.

Recent Articles

Medicaid Malpractice

We knew it would happen, but that doesn’t quite reduce the sting.

In September, I wrote about a proposed waiver to Kentucky’s Medicaid program, which would foist work requirements on recipients (among other patronizing indignities like premium payments and “health incentives”) and would devastate Kentucky’s large newly insured population. Those work requirements directly conflicted with the federal Section 1115 waiver guidelines, which govern what’s allowable in Medicaid waiver requests.

This week, at a National Association of Medicaid Directors conference, Seema Verma, head of the federal Centers for Medicare and Medicaid Services, indicated that states could request waivers that would permit officials to impose work requirements as a condition of receiving Medicaid. Which means, according to Kentucky’s Medicaid Director Stephen Miller, the state’s waiver request will be approved “soon.”

Verma defended the changes this way: “Believing that community engagement requirements do not support the objectives of Medicaid is a tragic example of the soft bigotry of low expectations consistently espoused by the prior administration,” she said.

The “soft bigotry of low expectations”? This phrase brings two thoughts to mind.

First, what about the hard bigotry of requiring people to prove their worth to receive health care? That’s what Medicaid “community engagement requirements” (read: work and volunteer requirements) represent. These requirements would force the poor and low-income people who would be subject to these rules (and most of whom are already working) to prove that they are worthy of assistance—in this case, worthy of having good health.

Such requirements often include difficult reporting requirements like documenting each hour of work, and limited flexibility if family or other emergencies arise. They are based on the flawed assumption that people in poverty are lazy—a stereotype that has been disproven again and again.

Second, work requirements just don’t work. So, “low expectations”?

My low expectations have nothing to do with poor people who receive Medicaid, and everything to do with Republicans who make false claims about how “hard work” will improve people’s lives, based on inaccurate ideas of who is poor and why.

I have low expectations that unemployed people who receive Medicaid will be able to find good work—not because they aren’t motivated to find work, but because the abysmal unemployment that plagues many areas in Kentucky and other states will be ignored by Republicans.

The consequences (and causes) of poverty don’t help either, like limited formal education, lack of employable skills, and lack of access to transportation. And since the Trump administration ended rules that would have made it easier for people on welfare to participate in job training, I also have low expectations that Republicans will facilitate participation in such programs.

Plus, even though most people on Medicaid work, many of those jobs are in retail, food service, and construction—sectors that often have variable and inconsistent payroll hours. It’s challenging to meet arduous reporting requirements, like the 20 hours of work per week requirement proposed in Kentucky, if one week you’re scheduled for 25 hours but the next you get 10. And Kentucky nonprofits have already indicated they don’t have the capacity to create new volunteer positions for anyone who wants one.

In short, I have low expectations that any policy that is based on false assumptions about the poor will in any way help them in escaping poverty. Instead, these policies, which reinforce stereotypes of the lazy poor person, are designed simply to push people off of assistance programs in order to limit welfare, decrease the size of government, and save money.

Remember that under past administrations, work requirements were at odds with Medicaid waiver guidelines. So what did the Trump Medicaid officials do? They simply rewrote the rules. “Seemingly, they did that so they could push through Kentucky’s waivers and other waivers after that,” says Dustin Pugel, research and policy associate at the Kentucky Center for Economic Policy.

In her conference remarks, Verma said, “The thought that a program designed for our most vulnerable citizens should be used as a vehicle to serve working-age, able-bodied adults does not make sense.” The problem with this statement is that poor working-age, able-bodied adults are some of our most vulnerable citizens. But in Kentucky, Medicaid expansion allowed this population to finally access health care. New Medicaid recipients began accessing preventative services, and were more likely to seek care for chronic conditions like diabetes. The state got healthier.

The Trump administration is putting those gains into jeopardy—as it will for any Medicaid expansion state that is granted a waiver. In Kentucky, “the changes will result in at least 95,000 fewer people covered, primarily because they can’t keep up with the requirements,” says Pugel. Medicaid provides health care for low-income people. The Trump administration twists this objective into nothing more than shaming the poor.

Retirement Savings Crisis Continues to Take a Back Seat on Capitol Hill

The Republican tax plan doesn’t touch 401(k)s as feared, but these accounts still don’t meet the retirement needs of most Americans.

Ron Sachs/picture-alliance/dpa/AP Images
Ron Sachs/picture-alliance/dpa/AP Images Representative Kevin Brady speaks as Senate and House Republicans announce their new tax plan at the Capitol trickle-downers_35.jpg The recently-released tax plan did not include the proposed changes to 401(k) contribution limits discussed in this article, likely due to the backlash against the initial idea. Yet as Thomhave explains here, most Americans do not use 401(k)s as a vehicle for their retirement savings. Earlier this year, the Trump administration and the Republican Congress began eliminating measures that could have bolstered Americans' abilities to save for retirement beyond inadequate 401(k) plans. O ne of the many dubious particulars of the Republicans’ new tax proposal is the way they’re considering paying for it: reducing Americans’ ability to save for their retirements through 401(k)s. The GOP’s plan is to offset the huge cost of tax cuts for the wealthy by limiting tax-deferred contributions into traditional 401(k)s, whittling...

How the Prison Phone Industry Further Isolates Prisoners

The high profits of expensive phone calls and video visits are often too lucrative for prisons—which can get a share of those profits—to pass up.

(Shutterstock) trickle-downers.jpg W hen inmates are able to speak to friends and family while incarcerated, it not only improves their lives, but also, studies have shown, reduces recidivism after they leave prison. But to fill in budget holes or to make a profit, many state and local governments work with companies that put a high price tag on this basic need for the incarcerated. A handful of companies monopolize the prison phone industry, and their control of the market allows them to charge exorbitant rates for inmate calls to their homes. States that contract with these providers tend to choose the contractor that provides not the lowest price, but the highest commission rate for the state. As a result, prisoners and their families may pay up to $1 per minute on a call. In addition to the lucrative phone call industry, prison phone companies have begun to dabble in providing video visitation services, mostly to jails. Instead of meeting a prisoner in person, friends and families...

Welfare Hypocrisy at Work in Washington

Republicans say that work trumps welfare. So why didn’t Trump’s Health and Human Services Department approve an Ohio plan to help welfare recipients get jobs?

(AP Photo/Alex Brandon)
(AP Photo/Alex Brandon) I n 2015, Ohio officials contacted the Department of Health and Human Services with a request to change state work requirements for Temporary Assistance to Needy Families, the program commonly known as welfare. Federal TANF requirements prioritize work over education and training, and Ohio officials wanted to make it easier for low-income parents to access training programs that could help them secure better jobs. Ohio based its proposal on a 2012 Obama administration memo , which invited states to submit proposals to modify TANF work requirements to “[help] parents successfully prepare for, find, and retain employment.” Under federal rules, there are strict time limits on job-hunting and education and training programs. Ohio wanted to secure permission for TANF recipients to “engage in activities that make sense based on their individual circumstances.” State officials sought to max out the vocational training time limit from 12 months to 36 months, since many...

Kentucky Sends an Ominous Signal About The Future of Medicaid

The Bluegrass State aims to become the first state to implement Medicaid work requirements. But it’s not the only one moving in that direction.

Bac Totrong/Daily News via AP
Bac Totrong/Daily News via AP Kentucky Governor Matt Bevin speaks in Bowling Green /*--> */ The Trump administration recently announced that states could implement work requirements for Medicaid recipients. On January 12, Kentucky’s request to introduce those work requirements, as well as other changes such as premium payments and removing retroactive coverage, was approved. Kentucky becomes the first state to tie work requirements to Medicaid coverage. Due to the approval of work requirements and other changes, nearly 100,000 Kentuckians are estimated to lose Medicaid benefits. In September, The American Prospect explored the Kentucky case and how the changes its Medicaid officials want to make will affect vulnerable Kentuckians. W hile congressional Republicans may have given up on their latest attempt to repeal the Affordable Care Act, Kentucky is moving ahead with other ways to pare back Medicaid, the 50-year-old program that provides health insurance for poor and low-income...