Not Doing So Welfare These Days

The Trump regime reportedly has welfare programs in their sights as part of GOP across-the-board austerity cuts, and that means every part of the safety net for the working poor and unemployed has to take a hit.

Trump administration officials are mulling an executive order that would instruct federal agencies to review low-income assistance programs, part of a coming effort to make sweeping changes to the country’s welfare system.

The White House began circulating a draft order to federal agencies for comment last week, according to two administration officials, who were granted anonymity to discuss the internal deliberations.

One of the officials said the draft order calls on agencies to review existing regulations and propose new rules that conform to a set of broad welfare principles, including tighter work requirements that encourage recipients to shift back into the labor force.

The order also calls for streamlining or eliminating duplicate services and establishing metrics for holding agencies accountable for program performance. It also encourages greater cooperation with state and local governments.

The initiative comes as President Donald Trump shifts attention to his ambitious tax reform initiative in the wake of his failed effort to repeal Obamacare. Administration backers of the welfare executive order hope he signs it before Thanksgiving, one of the officials said.

Trump has mostly backed off his train of executive orders that marked the opening months of his regime, apparently having picked all the low-hanging fruit when it comes to erasing Barack Obama's legacy from existence, the rest will require Republicans in Congress to act (and take the blame).

But as with the Affordable Care Act, the executive branch is still quite capable of sabotaging the implementation of programs like SNAP, WIC, housing assistance, and more to the point where they will fail to work at all, and then Republicans can claim they're doing us a favor by getting rid of them.

The major austerity is coming with the next GOP budget. Until then, Trump's sabotage will do in a pinch.  But red state governors and state legislatures are more than happy to cooperate with the GOP sabotage of government in general.  Just look at what's happening to rural hospitals in red states that have refused Medicaid expansion, like my beloved western North Carolina where I grew up, where women like Lucia Parker will have to drive at least an hour to get to a hospital with a maternity ward now as hospitals are closing maternity wards just to stay open.

As Congress debates repealing and replacing the Affordable Care Act, rural hospitals are in a kind of purgatory, unsure about their Medicaid budgets and the private health insurance that sustains them. At least 81 rural hospitals have shut down across the country since 2010, according the North Carolina Rural Health Research and Policy Analysis Center at UNC. The pace of closures has been increasing since the Great Recession, but the current health care policy limbo—which leaves hospitals and insurers unable to predict their income—exacerbates the problem. “The uncertainty is really impinging providers, particularly hospitals, from making the kinds of decisions that might put them on a better footing,” says center director Mark Holmes. 

Parker lives in an impoverished swath of rural Appalachia where the hospitals are particularly vulnerable. In her Congressional district, 20 percent of families with children live below the poverty line and more than 40 percent of residents—roughly 318,000 people—rely on some form of publicly-funded health care. Another hospital in the district, Angel Medical Center in Franklin, North Carolina, shut down its maternity ward in July, after officials said the unit was losing $2 million a year. And Parker’s congressman, Republican Mark Meadows, has not intervened to keep them open. The Freedom Caucus chairman has been one of the nation’s most vocal critics of Obamacare, favoring legislation that ends insurance subsidies and makes deep cuts to Medicaid. 

Any cuts to Medicaid would hurt rural hospitals, says Diane Calmus, government affairs and policy manager for the nonprofit National Rural Health Association. Seventy-five percent of patients in the Mission Health system—the nonprofit that runs Blue Ridge, Angel, and four other western North Carolina hospitals—are either uninsured or on Medicare or Medicaid. These hospitals were especially hard hit when the Republican-led North Carolina General Assembly refused to expand Medicaid in 2013. Eighteen other states made the same decision, and the impact was clear: more than 70 percent of the rural hospitals that shut down in the past seven years were in 16 of those states. Four hospitals in rural North Carolina have closed since 2013, and Blue Ridge has been losing money every fiscal year since 2013. Last year it lost $3.1 million. Charity care—services that no one pays for—at rural hospitals has increased more than 50 percent since Obamacare passed. “We have a rural hospital closure crisis,” Calmus says. 

Holmes and other experts say the lack of Medicaid expansion is not the only cause of the crisis. They point to low Medicaid reimbursement rates, patients who can’t afford their deductibles, consolidation of hospital ownership, declining rural populations, medical staffing shortages, and a longstanding trend of Southern hospitals struggling to make ends meet. “You really have a death by a thousand paper cuts situation here,” Holmes says. But if a hospital wants to stay open, Calmus says, it may close a unit that is well-known for losing money: the maternity ward.

It's red state Trump voters in rural GOP districts who are going to get hurt the most by the Trump regime's austerity cuts.  They're going after not just the safety net, but the entire health infrastructure that keeps America together just to give the richest Americans another million a year in tax cuts.

And remember, none of this matters to the Republicans.  They just want to destroy as much government as possible in order to justify to voters why massive draconian cuts are necessary in order to make the rich who donate to them richer.