According to a recent analysis from Georgetown University, enrollment in Medicaid and the Children’s Health Insurance Program (CHIP) declined from 74.6 million in January of last year to 72.4 million in January of 2019, representing a drop of approximately 3 percent. It also means that some 860,000 children of low-income families no longer have access to health care services. The analysis, conducted by GU’s Center on Children and Families (CCF) was based on data from the Centers for Medicare and Medicaid Services (CMS).

Current CMS Administrator Seema Verma says the reason is improvements in the US economy over the past two years. In a Twitter post, she wrote, “It’s always been clear that as the economy improves, unemployment drops & incomes grow…people move off of public assistance programs like Medicaid.” However, others familiar with the Medicaid program say this is not necessarily the case.

Calling out Verna on her claims, CCF executive director Joan Alker points out that the decline in Medicaid enrollment has far less to do with job growth and employer-based coverage than it does to excessively burdensome re-certification processes and Trump’s cuts in enrollment education and outreach funding. Another factor is fear among families whose members include immigrants and the current Administration’s draconian actions on immigration who attempt to avail themselves of virtually any publicly-funded service. Last October, the Department of Homeland Security published a proposal that would allow immigration officials to consider a legal immigrant’s use of public services such as Medicaid to deny an application for permanent resident status. That proposal, which drew massive criticism by health care advocates, has not yet been instituted.

According to Families USA, the fall in Medicaid enrollment is primarily due to “state paperwork barriers,” which accounted for 1.5 million low-income people being dropped from the program. The organization’s report notes that while the problem of “churn” is not a new one in the Medicaid program, regulations under the Affordable Care Act prohibit many of these procedures. However, a number of states, primarily in “red” regions of the country, are ignoring these regulations, placing huge and needless burdens on people that may, in fact, qualify for Medicaid.

It is worth noting that Ms. Verna, a “right-wing darling,” was nominated to her current position by Trump. Prior to that, she was an architect of Indiana’s so-called “Healthy Indiana Plan,” which required low-income recipients to pay into a “health savings account” or face being dropped from the program. The plan also had very high deductibles, and was described by The Guardian as “punitive.” Later, she worked with then-governor Mike Pence on “Health Indiana Plan 2.0,” an alternative to the Medicaid expansion, which was not much better. It was based on ideas put forward by her own health care consulting business, SVC, which she operated while in the employ of Hewlett-Packard, one of Indiana’s biggest Medicaid vendors. Not surprisingly, Verna earned a tidy sum for herself while securing hundreds of millions of dollars in state contracts.

K.J. McElrath is a former history and social studies teacher who has long maintained a keen interest in legal and social issues. In addition to writing for The Ring of Fire, he is the author of two published novels: Tamanous Cooley, a darkly comic environmental twist on Dante's Inferno, and The Missionary's Wife, a story of the conflict between human nature and fundamentalist religious dogma. When not engaged in journalistic or literary pursuits, K.J. works as an entertainer and film composer.