Vox

By: Dylan Scott

The story of Medicaid so far has been of gradual expansion, from the absolutely most vulnerable Americans to a broader social safety net for all Americans in or near poverty. But now, under Trump, the Centers for Medicare and Medicaid Services have signaled that they are open to unprecedented policy changes, most notably requirements that many Medicaid beneficiaries either work or look for work.

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It is a remarkable reversal, Medicaid experts say, from the way waivers have been used in the past to expand health coverage. “We’re just talking about ways to cut coverage,” Joan Alker, executive director of Georgetown University’s Center for Children and Families, told me. “Under any previous administration, waivers have not been used to devise ways to cut coverage.”

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“From a larger perspective, I think this is very concerted effort to stigmatize Medicaid and to set up for the next round of block grants or per capita caps. That’s the holy grail,” Alker said. “To reinforce inaccurate notions of who is on Medicaid, to reinforce stereotypes that it’s lazy people who are not working, even though we know that’s not true.”

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