A question of 'worthiness': GOP pols and the people they're cutting off from core health programs

Yahoo

10-06-2025

A sign displayed by U.S. Senate Democrats at a Washington, DC press conference on Feb. 19, 2025. (Photo by Shauneen Miranda/States Newsroom)
Modern public policy debates – particularly those surrounding matters of government budgeting – frequently delve into and hinge on complex issues of public finance and economic forecasting.
The current divide between North Carolina Senate and House Republicans over whether to slow down or plow ahead with scheduled income tax cuts is a classic example. The ultimate decision will hinge in large part upon which economic projection carries the day – the Senate's assessment that state revenues will remain strong even with new tax cuts, or the House's take that the nation's softening economy, along with big federal budget cuts, provide grounds for caution.
For many other important debates, however, the criteria lawmakers will ultimately use in making their decisions are not nearly so grand or data driven. Indeed, in many instances, the basis for the decision will come down to a question rooted in gut instinct: Are the people who will benefit worthy?
Seriously. This is not a parody or an exaggeration. Right now, Republican elected leaders in Washington and Raleigh are advancing major changes to how the nation and state dispense social safety net benefits, based not on a complex calculus about how the decision will improve societal outcomes, save lives, or even save the government money.
Instead, the changes are premised on the sponsors' belief that the people to be cut off from assistance don't deserve it. It's really that crass and simple.
The prime example of this brand of decision making is the plan to impose work requirements on Medicaid health insurance enrollees. Under the so-called 'big, beautiful bill' narrowly passed by the U.S. House at President Trump's behest late last month, millions of current low-income program participants will be required to regularly prove that they are working a prescribed number of hours each month, or that they fit into a number of vaguely worded exemptions.
In other words, according to the scheme, poor people who work fewer hours or sporadically at odd jobs (as is so common among many people of modest means trying to scratch out a living) do not deserve health insurance.
Never mind that verifying the work status of millions of people on a regular basis will necessitate the creation of a vast new government bureaucracy. Never mind the research that shows millions of poor people will lose coverage because they lack the wherewithal (computers, transportation, basic literacy) to properly document their work histories. Never mind the research showing that such a change would bankrupt hundreds of community health centers that rely upon Medicaid reimbursements. Never mind that this will, in turn, result in a flood of struggling people inundating hospital emergency rooms. Never mind that thousands of people will experience premature deaths.
In a recent interview with NC Newsline, Sara Rosenbaum a Professor Health Law and Policy at the George Washington University, who recently published a report on work requirements, derided the policy as the latest iteration of the infamous English Poor Laws of 1601 that likewise conditioned public aid on supposed worthiness. 'It's inconceivable to me that we would, in 21st Century America, tell [a poor person] 'you're not worthy,'' Rosenbaum said.
Meanwhile, two program reductions advanced by GOP budget writers in the North Carolina General Assembly recently appear to be cut from the same maddening cloth.
The first would eliminate a state Department of Health and Human Services program launched in 2022 called 'Healthy Opportunities.'
The program, which has operated as a pilot project in three counties, is based on the simple premise that helping people enrolled in Medicaid with food, transportation, housing, and other non-medical health-related needs would improve their physical health.
And you know what? It did. Program participants were healthier and ended up in hospital emergency rooms less. Indeed, when researchers compared health care costs in the 12 months before and the 12 months after enrollment in Healthy Opportunities, they found cost savings of 85 dollars per person, per month.
Unfortunately, like their colleagues in Washington, North Carolina lawmakers appear to have decided that recipient 'worthiness' is more important than saving lives and money, and so unless saner voices prevail, the program will go away.
And the same appears to be true for Medicaid coverage of weight-loss prescriptions. As Jonathan Ray – a Charlotte physician assistant – wrote in a recent essay for NC Newsline, 'obesity is not merely a matter of personal responsibility; it's a complex health issue influenced by various factors, including genetics, environment, and socioeconomic status.'
And these medicines (like Wegovy and Ozempic) have, he added, helped thousands upon thousands of people to achieve significant weight loss, improve their metabolic health, and reduce the risk of chronic diseases like diabetes and heart disease. Unfortunately, obese people too have been deemed insufficiently worthy, regardless of the potential savings in lives and money the drugs might help secure.
In short, try as they might to portray their actions as being about protecting the public purse, the hard truth is that affluent modern American politicians are, like their predecessors in late Medieval England, smugly sentencing poor people whom they deem unworthy of aid to early deaths.