Saying that health care is a human right is a common rallying cry for progressives. In his own way, President Donald Trump may agree ― as long as he gets to define who qualifies as human.
The Trump administration has sought to narrow the definition of “human” from the very beginning, enacting policies that make it more difficult for people Trump and his supporters consider undesirable to get health care. Transgender people. Immigrants. The poor. Women who have had abortions. There’s a clear pattern in Trump’s health care policy choices illustrating his apparent view that some people simply don’t deserve help.
These policies are a small, mean component of the Republican Party’s long-standing goal to make sure that fewer Americans who need health care can afford it. They are also over and above the actions the Trump administration has taken to weaken the Affordable Care Act and create new restrictions on eligibility for government health care programs, as well as the efforts to get the judiciary to toss the entire Affordable Care Act and leave millions uninsured.
Trump is unilaterally using executive authority to eliminate health care for people who belong to groups he and his cohort want to see suffer because of who they are, without new congressional authorization. The ugliness is plain to see.
Apart from the potential for meager savings to taxpayers, these policies have no upside. They are deliberately designed to allow bigoted people to discriminate against Americans they don’t like and to make swaths of the population feel unwelcome and penalized. The cruelty is the point.
The latest installment is against transgender people. The administration has proposed a regulation that would allow doctors, nurses, hospitals and other health care providers to refuse to give medical care to someone simply because they are transgender. This is the same Trump who campaigned as an ally to LGBTQ Americans.
This proposed rule would reverse a policy implemented under the Affordable Care Act forbidding health care providers and insurance companies that receive federal money (which is nearly all of them) from discriminating against transgender people. Discrimination against transgender people has been rampant in the American health system and that policy was meant to at least partially address the problems they face.
The Trump administration justifies this as part of its larger effort to protect the “consciences” of religious Christians, such as rules allowing pharmacists to refuse to dispense contraceptives. This new rule seeks to alleviate those crises of conscience by giving medical providers license to deny medical treatments to people they don’t like for being who they are. The same rule allowing discrimination against transgender people would permit medical professionals to deny treatments to women who have had abortions.
Indeed, under Trump, the Office for Civil Rights at the Department of Health and Human Services is now oriented more toward protecting those who seek to violate civil rights with impunity than toward protecting those who are vulnerable to discrimination. It should come as no surprise that Vice President Mike Pence has stocked the department’s leadership with his acolytes.
The Trump administration has carried out a sustained assault on immigrants, both documented and undocumented, from the beginning. While denying immigrants access to health care may pale in comparison to caging their children and letting them die, it’s part of the same campaign to penalize and dehumanize them to please Trump’s most hateful supporters.
There have long been many limitations on the government benefits, such as Medicaid and health insurance subsidies, that immigrants, including legal U.S. residents, can receive. Undocumented immigrants are ineligible for virtually everything, save a few emergency programs. Lawful permanent residents with green cards must be in the United States for five years before qualifying for most forms of assistance, and similar rules apply to refugees, people seeking asylum, and those who are victims of domestic abuse or human trafficking.
This is not harsh enough for Trump and for people who disdain immigrants, especially those from Latin America.
Last month, Trump issued a memorandum instructing federal agencies to punish immigrants and their families via a little-used clause of a 1996 welfare reform law. Under Trump’s vision, people who sponsor immigrants could be required to reimburse the federal government if those immigrants enroll in benefit programs like Medicaid and food assistance.
Relatedly, the Trump administration also is considering a policy to allow it to deport lawfully residing immigrants who use federal programs.
The only plausible reason for pressing these matters now is to discourage people from helping relatives or others come to America, and to discourage documented immigrants from taking advantage of programs for which they’re eligible. The success of these policies will be measured by how many immigrants get sick or go hungry as a result.
And then there is Trump’s array of policies that are hostile to low-income people. The administration has implemented or proposed a plethora of new limits on assistance programs, and created barriers to enrolling and keeping benefits like Medicaid and food assistance.
The Trump administration has encouraged states to impose work requirements on Medicaid enrollees. This policy seeks to solve an almost nonexistent problem and is based on ugly ― and racialized ― stereotypes about lazy poor people that date back to President Ronald Reagan’s condemnations of “welfare queens” and “strapping young bucks.”
Until a federal judge put a stop to it (for the time being), Arkansas, the first state to introduce work requirements to Medicaid, kicked about 18,000 people off the program for noncompliance. Never mind that a big reason they hadn’t complied was that people had poor internet access and could only report their work status via a state website, and never mind that those who don’t work live in areas with few jobs, and never mind that some evidence suggests these requirements actually make it harder for low-income people to work.
Trump’s overall position on Medicaid is clear, as well. His budgets call for huge cuts to the program. The Affordable Care Act repeal bills that Trump supported in 2017 all would have drastically slashed the program’s funding. That legislation failed, so Trump is trying to achieve a similar result by offering states the ability to replace current funding with a “block grant” approach that would result in less money and fewer people covered.
And then there’s Trump’s new push to simply redefine “poverty” so that fewer people meet that definition and would be eligible for Medicaid and other assistance programs. This could result in more than 1 million people losing health benefits over 10 years, according to an analysis by the Center on Budget and Policy Priorities. It wouldn’t make any of those people less poor, it would just make people who are already poor even worse off.
To some Americans, this combination of policies may seem punitive and even cruel. To Trump and many of his fans, that’s the point.
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