I have some minor medical issues. So do my kids. Tracking all our medical appointments, getting to the appointments, getting prescriptions, getting insurance to pay for the appointments and prescriptions, paying the bills – this takes up a not insignificant amount of my time and brain space.
I am not awesome at handling administrative burden, but I can do it. Not everyone can.
Imagine you are working full time at a low-paying job that does not provide health insurance. Maybe you have kids to take care of in the hours you aren’t working. Maybe you have medical issues or just want to try to stay healthy. So you try to do the responsible thing and get health insurance through Medicaid.
That requires navigating MO HealthNet, Missouri’s chronically dysfunctional Medicaid system. It might mean spending hours on hold with the agency, going in person or dealing with them losing your documents. It’s an ordeal. But let’s say you eventually manage to get it done.
Thanks to the new work requirements in Republicans’ “One Big Beautiful Bill” you now have to go through the ordeal again twice a year to prove you are working and still qualify (or prove you are sick enough to deserve health insurance). Proving you are still eligible is not easy, especially if your employer changes how many hours you work, you’re a gig worker, you lose your job, you don’t have internet, you can’t get to the office, the office is closed, you didn’t get the renewal letter or you did get the renewal letter but it is incomprehensible… the list goes on.
What if you don’t have the time or skill to navigate all this bureaucracy?
Republicans are counting on you not being able to get it done.
The Medicaid savings in the federal law are expected to come from people not being able to jump these hurdles. Republicans claimed with straight faces that the savings would come from eliminating “fraud, waste, and abuse.” But let’s be real: this isn’t about fraud.
Our Republican lawmakers know many people are too poor, tired or swamped to manage the deliberately imposed administrative burden. Their plan has always been to reduce Medicaid spending by red-taping as many people as possible out of their health insurance.
And it’s not just low-income people on Medicaid who can’t handle the administrative burden imposed by the federal law. You know who else can’t? The states. Especially Missouri.
Our system was already a mess. We do not have the staff or computer systems to efficiently require people to jump through the new additional hoops. But the federal law’s new work requirements require us to blowtorch millions of state tax dollars in the attempt.
Missouri estimated the added administrative costs would amount to $294.6 million. That was before the Trump administration imposed even more arduous rules for sick people this month.
Missouri Republicans, rather than trying to figure out how we are going to pay for this, tried to put work requirements in our state constitution.
There was a time when Republicans decried red tape and over regulation. Now it is their favorite weapon.
I’m most familiar with this in the abortion context. When Roe was the law and abortion couldn’t be banned outright, the strategy was to impose medically inappropriate regulations so onerous that abortion clinics couldn’t function. Those laws are still on the books in Missouri, which is why it remains nearly impossible to end a pregnancy in a timely manner here despite Missouri voters voting to legalize abortion. When voters aren’t with Republicans, or Republicans are otherwise blocked by law, Republicans achieve their goals through red tape.
Where Republicans have really taken the red-tape strategy to the next level is in their attempt to keep more people from voting.
Do you know where your birth certificate is? I do not. I have a passport, but half the country does not. I didn’t change my name when I got married, but most women do. This means they will have a problem if President Donald Trump’s prized SAVE Act becomes law because it will make proving eligibility to vote extremely document-intensive. I’m not talking about just locating documents, but getting new ones. SAVE is intended to keep people who are statistically less likely to vote for Republicans, like women and low-income people, from voting. By burying us in administrative tasks.
Republicans, in Missouri and at the federal level, have somehow made “small government, less regulation, less red tape” their brand. The truth is they are all about red tape. They will go to the mat to impose as much red tape as possible. They will spend endless legislative time, dollars and political capital to impose more red tape.
This is because red tape is effective. Republicans want those of us who don’t have all our documents together and are short on time to spend as much work and money as possible to exercise our basic rights.