Thread by @rebeccavallas

BREAKING: Trump has officially ended Medicaid as we know it, by allowing states to take health insurance away from people who can't find a job.

(Please RT to spread the word.) 1/

With the GOP unable so far to repeal the ACA and destroy Medicaid through legislation, Trump's decided he's done waiting for Congress. 2/

According to a letter to state Medicaid directors, states will now be allowed to strip most working-age people of Medicaid if they aren't working or participating in qualifying activities for a set number of hours per week. 3/

Adding so-called "work requirements" to Medicaid has long been on the GOP wish list. Most recently, Congressional Republicans tried and failed to do this through legislation, as part of ACA repeal efforts. 4/

And GOP governors in a slew of red states have been chomping at the bit for the OK from Washington to do this.

While all eyes were on the healthcare debate in Congress, at least 6 states requested authority to do so last year alone. 5/

As many as 10 such requests are currently pending, with many more sure to follow.

Today's announcement is expected to kick off approval of those requests, likely starting with Kentucky. 6/

While the letter is cloaked in puppies and rainbows language about "community engagement," make no mistake. This is Trump #destroyingMedicaid by ending the program's core promise of providing coverage to all eligible people. 7/

Taking health insurance away from struggling workers isn't just heartless--it's also incredibly boneheaded.

Study after study shows having health insurance doesn't just lead to better health--it translates into increased work capacity, and in turn higher wages & earnings. 8/

On the flip side, the nation's preeminent experiment with work requirements shows they not only fail to improve long-term employment outcomes--they actually leave people worse off. 9/ americanprogress.org/issues/poverty…

At their core, work requirements are premised on a set of myths about poverty:

- that "the poor" are people who "just don't want to work"

- that anyone who wants a well-paying job can snap her fingers & make one appear

- that having a job is all it takes to not be poor

10/

Reinforcing these myths is core to Trump's divide and conquer playbook. That's why he's so keen to smear Medicaid and other popular programs as "welfare"--a dog-whistle with a deeply racially charged history. 11/

By using dog-whistle terms like "welfare" he's betting he can paint people who turn to Medicaid & other public programs to make ends meet as modern-day "welfare queens"--so we don't notice he's coming after the entire working and middle class. 12/

The letter announcing the policy says it won't apply to pregnant women or to people who qualify for Medicaid on the basis of disability.

But the guidance itself admits that this will fail to protect the countless people with disabilities who don't fall into that bucket. 13/

The guidance also admits that lots of folks may need "supportive services" to work or find work--job search help, disability supports, transportation etc.

But it then makes clear states CAN'T USE FEDERAL MEDICAID FUNDS to pay for these services. 14/

A recent study out of U. Michigan looking at work status of Medicaid enrollees shows what a disaster this policy will be for people with disabilities & health conditions. vox.com/policy-and-pol… 15/

Of the state's Medicaid enrollees not currently working:

- Two-thirds reported a chronic physical illness

- 35% reported a diagnosed mental illness

- One-quarter reported a physical/mental condition that interfered with their ability to function at least half the time.

16/

^ These are the supposed freeloaders Trump's so worried about. 17/

Here's how this will play out. Anyone with a disability or health condition who isn't in receiving Medicaid on the basis of disability will have to prove their condition to the state's satisfaction. 18/

I can tell you from my legal aid days how hard this will be for the very folks MOST in need of health insurance. Many will end up caught in red tape and paperwork. Victims of bureaucratic disentitlement. 19/

The American people voiced their opposition to cutting Medicaid loud and clear all throughout 2017, shutting down GOP efforts to do so through legislation. So Trump decided to take matters into his own (tiny) hands and do it himself by fiat. 20/

Litigation will follow, as legal experts have noted conditioning Medicaid coverage on work violates the Medicaid statute. Follow @NHeLP_org who will be a leader here. 21/

In the meantime, RT this thread to spread the word -- and join the #HandsOff campaign at handoff.org to help fight this and other attacks on healthcare and the other basics families need. /end (for now)

Argh, typo! Join the #HandsOff fight at handsoff.org — need that S in there!