Trump’s back-door repeal of Obamacare going unnoticed?

Catherine Rampell

One of the bigger, and more heartening, surprises of the past year was just how fervently it turned out Americans supported health care for low-income people.

Republican politicians had been running against Obamacare — including its Medicaid expansion and income-based subsidies for buying insurance — from the moment the law passed. And the public appeared to back this agenda: The Affordable Care Act polled terribly.

Yet when push came to shove, and Republicans tried to dismantle the health care law, Americans fought back. Hard.

They marched. They showed up en masse to town halls, shaming and shouting down lawmakers. They jammed congressional offices and phone lines.

Even Trump voters, in focus groups, said they didn’t want to roll back Medicaid or other health coverage for lower-income people.

In broader polling, a majority of Republicans held favorable views of Medicaid and wanted its funding to hold steady or increase. Sizable minorities supported single-payer or a public option.

Clearly “Obamacare” itself had a branding problem, but on the more substantive question — whether it was government’s role to make sure Americans had health care coverage — Democrats won the fight.

Or so it seemed. Republican officials have, a bit less conspicuously than last summer, fought on.

Unable to roll back Obamacare’s health care expansion legislatively, they’re now doing so administratively, through regulatory changes.

This GOP effort ramped up last week, when the Trump administration began allowing states to erect barriers to Medicaid eligibility.

The Trump administration announced it would start allowing states to impose requirements other than income and assets on Medicaid recipients, including proof that they are working, looking for work, volunteering or in school.

But nearly 8 in 10 Medicaid-enrolled nonelderly adults already live in working families, and most (60 percent) are working themselves, according to the Kaiser Family Foundation.

Most who are not working report major impediments to their ability to get a job, such as illness, disability, school enrollment or caregiving responsibilities.

The Trump administration argues the work requirements will improve public health. Why? Because they’ll encourage more poor people to find jobs, and employed people tend to have fewer health problems.

This likely gets the causality backward, though, given how many Americans report illness as a barrier to getting or keeping a job.

State-level studies have found that Obamacare’s Medicaid expansion helped lower-income people gain work or remain employed; inversely, reducing long-term access to physical, mental and substance-abuse treatment is likely to hurt both health and employment prospects.

If the Trump administration wants to help more Americans find jobs there are more effective tools. Investing in skills, apprenticeships and job-matching services, for instance. Or expanding the earned-income tax credit.

Instead, Republicans are counting on the notion that a raft of wonkish-sounding waivers — unlike last year’s failed Trumpcare legislation — will inspire no riots, no rowdy town halls, no phone-line-jamming and no mass mobilization to protect health care for the nation’s most vulnerable.

Who wants to prove them wrong?