Ed Tibbetts, a longtime reporter and editor in the Quad-Cities, is the publisher of the Along the Mississippi newsletter, where this article first appeared. Find more of his work at edtibbetts.substack.com.
In February, House Speaker Mike Johnson of Louisiana justified the looming cuts to Medicaid by complaining the program wasn’t designed to cover a bunch of “29-year-old males sitting on their couches playing video games.”
Give Johnson credit: that is a powerful image.
Nobody wants their tax dollars going to pay for government health insurance for some dude who just hangs around his parents’ basement gaming while the rest of us have to haul ourselves out of bed each morning to go to work. Which is why Republicans have been focusing so much on the Medicaid work requirements in Donald Trump’s big, ugly tax bill.
They won’t admit the money they save by taking health insurance away from millions of poor Americans will go to finance tax cuts for some of the wealthiest families in the country. So, they falsely claim these cuts will protect the most vulnerable, who also are covered by Medicaid.
As I’ve previously pointed out, this claim is not true. If it were, the money they plan to save on these work requirements would go to trim Medicaid waiting lists or to bolster care for Iowans who rely on already struggling rural hospitals. But they don’t. They go to pay for tax cuts.
Still, the image of forcing that lazy, 29-year-old man off his couch and into the workforce is a powerful one, and it is the foundation of the Republicans’ campaign to sell Trump’s bill. (Editor’s note from Laura Belin: U.S. Representative Ashley Hinson has repeatedly used this frame. For example, she told some Iowa reporters in a conference call last month, “the intent of Medicaid is to protect those with disabilities, seniors, single mothers with children, not 29-year-old men playing video games on their mother’s couch in the basement.”)
The problem is this image also is not true.
A study published at the end of April demonstrates just who these “able-bodied” non-working people on Medicaid actually are.
- First, they’re rare. And, for the most part, they’re not men.
- Four out of five are women.
- Their average age is 41.
- One out of four is a woman over the age of 50.
- On average, they live in households of 4.4 people. They have no income of their own and the average income of their families is less than $45,000 a year.
Think about those images for a moment. How many of us know women who live in such struggling households? Who are just trying to get by. Who if they didn’t have Medicaid would have no health insurance at all.
As Republican Senator Josh Hawley of Missouri said the other day, his constituents on Medicaid aren’t malingerers. “They are on Medicaid because they can’t afford private health insurance.”
That’s true in Iowa, too.
The data I just presented comes from an article written by scholars at the LeadingAge LTSS Center at the University of Massachusetts, Boston and the Milken Institute School of Public Health at George Washington University. They studied comprehensive data from the U.S. Census Bureau’s American Community Survey, and their findings were published in Milbank Quarterly, which is a century-old journal of population health and health policy.
When I read this report, my eyes were truly opened.
Look, I’ve never believed the Republican claim that Medicaid is full of people who refuse to work. Plenty of research proves that most of them are, in fact, on the job—and that those who aren’t usually are caring for family or have health problems themselves.
Still, I never got a clear-eyed look at who these “able-bodied” people actually are.
It makes what Republicans plan to do even more wicked.
This research says Medicaid enrollees who are classified as “able-bodied” only represent about 16 percent of the total non-working Medicaid population between 18 and 64 years of age.
That’s a really small slice of the whole, and I find it hard to believe federal and state governments that oversaw unprecedented amounts of waste while trying to implement COVID-19 relief dollars appropriated by Congress without adequate safeguards are going to be able to find that rare 29-year-old male lounging on the couch playing video games.
More than likely, a whole lot of eligible, vulnerable people are going to lose their health insurance to the swirl of bureaucracy, which is what happened when states tried this before. This is precisely why politicians like Mike Johnson ignore the damage their bill will do, and they instead talk about all those “29-year-old males sitting on their couches.”
Images are powerful tools in selling legislation, and Republicans have proved themselves quite adept at conjuring up visions to try to convince people that their cuts don’t actually reflect hard-heartedness. Iowa Governor Kim Reynolds wrote an op-ed recently in the Washington Examiner, claiming these ideas reflect “compassion” and “common sense.”
But there is nothing compassionate, nor common sense, about cutting off health insurance for an impoverished 41-year-old woman with two kids struggling to get by just so you can make room in the federal budget for trillions of dollars of tax cuts, the most generous of which deliver roughly $89,000 to families who are making more than $1 million a year.
It’s the rare Republican in Congress—Hawley might be one of them—who can see that 41-year-old woman.
Instead, they try to sell you the vision of the 29-year-old dude.
As the New York Times put it recently, he’s the modern-day equivalent of Ronald Reagan’s “welfare queen” of the 1980s.
There are a whole lot of things wrong with the big, ugly bill congressional Republicans are planning to pass, and that President Trump really wants to sign. Maybe the worst is that instead of simply extending the 2017 tax cuts for the middle class, Republicans have loaded up this 1,000-page bill with deficit-raising goodies for the wealthy that, in the process, will simultaneously cause poor women to lose their health insurance.
Republicans like Mike Johson don’t want you to think about this. So, instead, they offer the public a different image. It is an image divorced from reality, intended to mask cruelty.
Top image is cropped from a photo posted on Ashley Hinson’s political Facebook page on September 6, 2024.