“We’re getting very creative.”
Those could be the words at the top of the résumé or LinkedIn profile for Dr. Alister Martin, New York City’s new health commissioner. Heaven knows, I’ll give him that much. It’s true! He, and others around him in New York state, are indeed getting very creative.
They are getting creative about, basically, how to effectively scam the government out of Medicaid funds by getting around new rules in the most preposterous way possible.
As a result of the One Big Beautiful Bill Act signed by President Donald Trump last year, there were ways to reduce the costs for the government by cutting down on entitlement abuses. One of these ways was work requirements for able-bodied individuals on Medicaid or Supplemental Nutrition Assistance Program benefits.
According to the Center for Health Care Strategies, if you’re between the ages of 18 and 64, don’t have an impediment to working or training, and you’re receiving aid through those programs, you need “80 hours per month of one or more of the following activities: employment; participation in a work program, such as job training; enrollment in an educational program (at least half time), community service activities, or a combination of these activities.”
“The rules are intended to push more people into the work force and reduce what Republicans have characterized as waste and fraud in government programs,” The New York Times reported Tuesday.
“States must now verify twice a year that many Medicaid recipients remain eligible, a requirement that is expected to result in many people losing coverage periodically, especially if their work hours vary or they move between jobs, or have difficulty navigating the paperwork requirements.”
While the state seems to have escaped what the biggest issue was — that of millions of people losing regular health-care coverage — that doesn’t mean they dodged a bullet. In fact, in New York City, this means that over half of the residents could lose Medicaid coverage.
“This is truly a seismic shift in Medicaid policy, the largest in the history of the program,” said Amir Bassiri, the state’s director of Medicaid.
Yes, a seismic shift in how New York does business: You have to work or aim toward working to get benefits. How draconian. Dickensian, even.
So, faced with something out of Dickens, New York countered with a bit of malevolent bureaucratic genius that even Franz Kafka or Joseph Heller might have appreciated.
“To keep as many New Yorkers as possible from being cut from the Medicaid rolls next year, state and city officials are looking for ways to prove that patients are afflicted with addictions or are medically frail, conditions that would exempt them from the new restrictions,” the Times reported.
“And they are considering how to sign people up for volunteer work — such as helping other New Yorkers navigate Medicaid’s new rules — which could satisfy the law’s work requirements.” [Emphasis ours.]
That’s how Dr. Martin says the city and others in New York are “getting very creative.” And indeed they are.
In fact, speaking of Heller, this could turn into a literal Catch-22. To be stripped of benefits, you must be able-bodied, between the ages of 18 and 64, and not working. But perhaps you need to learn about these benefits. So you can get a “job” volunteering to teach other people how to not be stripped of these benefits, thus meaning you can’t be stripped of these benefits.
The only thing more fitting is if it turns out one of the overseers of this boondoggle was named Dr. Doctor Doctor and actually only received his medical degree because of a clerical error regarding his given name.
Oh, but I’m sure there’s going to be the most rigorous of oversight as to whether this volunteer work is, like, actually happening and not just a no-show gig. Also, I’m the ghost of Ross Perot. Both of those statements are equally true.
Heck, this is preposterously easy to fix, if you want to go to lengths even Kafka or Heller couldn’t possibly comprehend. You could get two people to train each other on the new rules, so they both qualify!
And then get people to train other people to train people on navigating the new rules. And hire trainers to train the trainers. And so on, and so forth, until, bam, you’ve wasted an obscene amount of money and credibility just to ensure you didn’t lose a dime of the Washington, D.C., dole, and not a single person has lost benefits they should have lost, and not a single erg of productive energy has been expended.
To rot with Kafka and Heller. Even Keynes and his ditch-digging proposals would find this arrangement absurd.
Or, if John Maynard were still alive, still a proper Englishman and thus prone to being somewhat too polite, perhaps he’d just call it “getting very creative.”
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