Joe Biden speaks with the press on the South Lawn of the White House on Tuesday, March 28, 2023. (Demetrius Freeman / the Washington Post via Getty Images)
Originally published in Jacobin on April 3, 2023
Because the Biden administration refuses to make a public case for keeping alive the pandemic emergency declaration that led to a huge expansion of desperately needed programs like Medicaid, millions are about to lose their health insurance.
Americans alive today can consider themselves lucky, because as you read these words, you’re bearing witness to the unfolding of monumental history. No, not the transformative presidency of Rooseveltian ambition for the age of climate disaster that we’ve been promised since mid-2020, or even a Great Society–like major expansion of the often punishing US safety net. It’s the exact opposite in fact. Under President Joe Biden, Americans are currently witnessing one of the most significant contractions of the US welfare state since the Bill Clinton years.
In this case, the vehicle isn’t a radical, anti-government budget or legislation aimed at ending “welfare as we know it,” but a far more low-key strategy: Biden’s simple refusal to renew the public health emergency declaration for the coronavirus pandemic first issued three years ago.
As a result, this past Saturday marked the start of the government’s unraveling of the pandemic-driven expansion of Medicaid and the Children’s Health Insurance Program (CHIP), which saw enrollment in the programs swell 28.5 percent since February 2020 to a historic 91 million beneficiaries. Five GOP-controlled states got the ball rolling this past weekend on shunting people off the programs’ rolls, with all other states set to follow suit between May and July.
What this means is that, by the estimates of the Department of Health and Human Services (HHS), 15 million people are going to lose their health insurance over the next few months, including 5.3 million kids. Worse, based on historical trends, 6.8 million of those people will lose their Medicaid coverage in spite of still being eligible for it simply because of bureaucratic trifles: they’ll fail to renew their enrollment, something the emergency declaration meant they haven’t needed to do for the past three years, or because they’ve changed addresses, they won’t get the blue envelope letter in the mail for them to carry out their renewal.
The fact that this is happening under a self-proclaimed progressive president that wants to win back working-class voters makes this all the more galling. So does the fact that he’s undoing a major welfare state expansion that his right-wing predecessor Donald Trump put in place — the same man who may well wind up being his election opponent again in 2024.
Back Into Deprivation
Under the Families First Act, signed into law by former president Donald Trump in March 2020, federal subsidies for states’ Medicaid programs were made more generous, but on two conditions: as long as those states didn’t make being eligible for the program harder for their residents and as long as they didn’t kick anyone already enrolled in the program off their rolls. That meant that anyone who ended up crossing their state’s (sometimes absurdly paltry) income threshold for Medicaid in the years ahead didn’t stop being eligible, as they normally would, but rather kept their benefits. The law stipulated this would continue as long as the public health emergency Trump had declared over COVID-19 was in place.
Unfortunately, that emergency declaration is ending on May 11 thanks to the Biden administration’s determined efforts to “move on” from the pandemic, heralding the end of Trump’s Medicaid expansion. In fact, the effects of the declaration’s end will go well beyond this, affecting working people’s ability to get free tests, vaccines, and affordable treatment for the virus. It also means the end of extra food stamps, another generous program set to continue as long as the emergency exists and a vital lifeline for working people struggling to keep up with grocery bills in the face of inflation.
But it’s the mass disenrollment from Medicaid and CHIP that’s arguably most alarming. As anyone who has to navigate the dysfunctional, corporate-controlled US health care system knows, those who aren’t covered by the government often have no good options. Not having insurance can in the worst of times be a death sentence, while getting it is either prohibitively expensive or requires having a job — and even then, you can still be screwed over by insurance companies six ways to Sunday if you get sick.
All of this makes the large number of people who are about to lose their Medicaid and CHIP benefits even more alarming. One single mother in Texas who suffered numerous complications after a pregnancy told the Washington Post that keeping her Medicaid coverage after the birth “probably saved my life,” a benefit new mothers won’t get when the state unravels the program’s expansion. Another single mother in Michigan suffering from bipolar disorder worries that she now falls perfectly into the income gap that leaves her too poor to afford health care but not quite poor enough to still get Medicaid. Busy Missouri pediatricians warned NPR it would mean a return to pre-2020 days when they were turning sick children away left and right. One Arkansas man told ABC that losing his coverage would mean having to choose “whether I would eat or whether I will get my medication.”
Then there’s the administrative chaos this is about to set off, as state governments take on the monumental task of sifting through tens and hundreds of thousands of enrollees to figure out who’s no longer eligible and who needs to be assisted to avoid losing their benefits, all while processing a sudden, massive influx of renewal applications, which can take months.
This would be a heroic undertaking at the best of times, but it will be made more difficult by the fact that many state governments are suffering from worker shortages, forcing them to press on while understaffed or with inexperienced workers who, having been employed during the pandemic, haven’t had to carry out renewals until now. Some states have hired extra staff to reach out to beneficiaries or spent millions on a public outreach campaign, all to try to prevent people from falling through the cracks.
Everything Wrong With Politics
From a practical and moral standpoint, this is obviously a travesty. But it’s also a needless own goal for the president, putting an already deeply unpopular Biden in the position of running for reelection in a year’s time with millions of people losing their health insurance — and his potential Republican opponent being able to boast he’d been the one to extend it to them in the first place. More than that, it makes a mockery of his frequent public statements insisting that his administration will “continue to fight for racial justice,” since, as the HHS, acknowledges, 15 percent of those who are about to lose their coverage as a result of his decision are black and one-third are Latino.
So why is this happening? Biden has made a recent rightward pivot since the hire of new chief of staff, vulture capitalist Jeff Zients, notorious for his longtime passion for spending cuts, a trait he shares with the president himself. With the heady days of 2021 and its talk of something like a new New Deal long behind him now, Biden is back to his career-long obsession with government debt, having put forward a budget earlier this month that aimed to cut the deficit by nearly $3 trillion, something the winding down of extra generous federal Medicaid subsidies will contribute to, if modestly.
The president has also seemingly long been particularly eager to treat COVID-19 as bygone, having reportedly taken some of his own staff by surprise last September when he declared on 60 Minutes that “the pandemic is over.” Those words had a knock-on effect at the time, assisting fierce GOP opposition to long-sought public health funding for COVID and even helping trigger some employers to announce the end of their own pandemic-related provisions.
A similar dynamic may be at play here. Twenty-five GOP governors called for an end to the public health emergency in December, in part complaining that it had “artificially” grown Medicaid rolls and was “costing states hundreds of millions of dollars.” Senate Republicans, meanwhile, have engineered repeated showdowns over the public health emergency to put Biden on the spot.
But if the idea is that Americans are now tired of thinking and caring about the pandemic, making supporting any COVID-related policies politically toxic, then this is the wrong way to go about unwinding those. Americans didn’t hate that the pandemic response included protecting them from being kicked out of their homes by greedy landlords, getting financial support for the government while they were unemployed, or having health insurance and a variety of other health care needs guaranteed. It was the elements that disrupted normal, daily life like forced mask-wearing, isolation, and even being coerced into getting vaccinated. The politically smart thing would have been to dismantle the divisive, behavior-based policies according to best public-health practices and work to hang on to, even institutionalize the bread-and-butter parts of the pandemic response that directly benefited working Americans’ pocketbooks.
Once upon a time, Biden’s own COVID plan said outright in the wake of the Omicron wave that “our path forward relies on maintaining and continually enhancing the numerous tools we now have to protect ourselves and our loved ones” — not by systematically taking apart those tools as soon as a bit of political pressure tried to end them.
Meanwhile, it pays to think about how the pandemic-expanded welfare state has been stripped away bit by bit these past two years in comparison, say, to the US response to the three thousand people murdered on September 11 twenty-two years ago. While a shocking crime, the government response to this unique and isolated event has been to continually throw untold amounts of money and expand an already invasive and bloated government bureaucracy without question, even as there’s little evidence doing so is keeping Americans safer.
Meanwhile, more than two-hundred people are still right now dying from COVID every day — meaning, a 9/11’s worth of US deaths roughly every two weeks — and the US political class can’t be bothered to keep in place the policies to fight it for more than two years.
The massive contraction in the US social safety net that we’re now witnessing under Biden embodies all that’s wrong with Washington politics, from ongoing Democratic timidity in fighting for working people’s needs in the face of right-wing attacks, to the misplaced priorities of elected officials. And while there’s a large chance this will become a political liability for the president, it’s the most vulnerable who suffer worst as a result.
Branko Marcetic is a Jacobin staff writer and the author of Yesterday’s Man: The Case Against Joe Biden. He lives in Chicago, Illinois.