At the Washington Post, Catherine Rampell has a piece about the complexity of bureaucratic requirements for various kinds of government assistance. She writes (boldface mine):
A government letter sent to an out-of-date address. An exhausted mother unable to make it to the social services office before the deadline. A non-native-English speaker having difficulty with a janky state website.
So far, these kinds of bureaucratic snafus appear to be the primary reason millions of Americans are losing Medicaid coverage this year and next.
Starting April 1, states around the country began disenrolling people en masse from Medicaid. This is the result of the end of a temporary, covid-era rule that required states to keep existing Medicaid beneficiaries on their books; in 2020, exchange for extra Medicaid funding, states had to err on the side of preserving access to health care during a pandemic. The public health emergency is over, though, and states can now revert to whatever renewal or termination policies they had pre-covid.
Even if those policies were pretty lousy at making sure people eligible for insurance actually receive it. And they often are…
To be clear, such dysfunction and administrative “churn” are not new; Americans have simply taken them for granted. Perhaps the silver lining of the purge is that with so many people affected at once, this large-scale government incompetence might become more conspicuous. Maybe at last the public will demand better.
This long-term problem requires a long-term solution: investing in state administrative capacity. At the very least, more states should step back and assess why so many of their residents are losing health coverage. Idaho, to its credit, recently paused its “procedural” Medicaid cancellations, citing an unspecified “technical” challenge. Iowa says it added a “safety check” to its Medicaid redetermination process, requiring a case worker to manually review materials before disenrolling households that haven’t returned renewal forms.
Alas, not all states seem motivated to ensure their own residents get the critical services they are promised — and owed.
While one should never underestimate the role incompetence plays, after decades of seeing this played out, it’s clear the issue isn’t incompetence, but a desire to throw people off the rolls. The last sentence of the excerpt (and her column) hints at this. But the ‘learned credulousness’ that Very Serious Pundits have is astonishing–and after the pandemic, which showed we don’t need those restrictions, it’s inexcusable. It should be clear that the complexity, until proven otherwise, is a feature, not a bug, from the perspective of many officials, including a fair number of Democratic ones.