Iowa Wants Its Poor to Give Up Smoking and Drinking to Qualify for Medicaid

Let our journalists help you make sense of the noise: Subscribe to the Mother Jones Daily newsletter and get a recap of news that matters.


The Obama administration gave Iowa a waiver today to expand Medicaid along lines similar to what Arkansas did earlier this year, in which Medicaid dollars will be used to buy insurance in the private marketplace. I’m OK with this as an experiment, and curious to see how it turns out. But there was another wrinkle to Iowa’s waiver application:

Iowa wanted to do something different. Gov. Terry Branstad (R) wanted to charge a small premium for Medicaid enrollees who earn between 50 percent and 133 percent of the poverty line. In the Arkansas plan, there were no premiums at all.

Health and Human Services essentially split the difference with the state here: They’re allowing premiums for those who earn between 100 percent and 133 percent of the federal poverty line, but not for those who earn below that. The premiums are limited at 2 percent of income (for someone at the poverty line, this is about $19 a month), and enrollees have the chance to reduce their payment by participating in a wellness program.

Hmmm. Iowa’s waiver application doesn’t describe this wellness program (a draft protocol will be submitted next March), but it does provide a hint about its goals:

The state shall submit for approval a draft section of the protocol related to year 1 Healthy Behavior Incentives including, at a minimum….the health risk assessment used to identify unhealthy behaviors such as alcohol abuse, substance use disorders, tobacco use, obesity, and deficiencies in immunization status.

A single person at 50 percent of the poverty line makes less than $500 per month. That’s obviously not someone who can afford even a nickel in extra expenses. But that was the income level in Iowa’s initial application, which means that for all practical purposes the original goal of this program was to (a) deny government benefits to poor people who are smokers, drinkers, drug users, or overweight, but (b) provide the benefits if these poor people agree to fairly intrusive government monitoring that ensures they improve these behaviors.

So here’s a question: what’s the liberal party line on this kind of thing? Are we opposed because conservatives are once again trying to deny benefits to the “undeserving” poor? Or are we in favor of this because using incentives to improve destructive lifestyles among the most vulnerable is a worthy effort? Does it matter whether the motivation for these incentives is something we approve of? If a lefty foundation launched a program that helped out poor families via a tough-love style approach that insisted on modifying destructive behavior, would it be OK? How much difference does it make that one is a public program and the other is private?

Comments?

SIX TRUTHS

Reclaiming power from those who abuse it often starts with telling the truth. And in "This Is How Authoritarians Get Defeated," MoJo's Monika Bauerlein unpacks six truths to remember during the homestretch of an election where democracy, truth, and decency are on the line.

Truth #1: The chaos is the point.

Truth #2: Team Reality is bigger than it seems.

Truth #3: Facebook owns this.

Truth #4: When we go to work, we're in the fight.

Truth #5: It's about minority rule.

Truth #6: The only thing that can save us is…us.

Please take a moment to see how all these truths add up, because what happens in the weeks and months ahead will reverberate for at least a generation and we better be prepared.

And if you think journalism like Mother Jones'—that calls it like it is, that will never acquiesce to power, that looks where others don't—can help guide us through this historic, high-stakes moment, and you're able to right now, please help us reach our $350,000 goal by October 31 with a donation today. It's all hands on deck for democracy.

payment methods

SIX TRUTHS

Reclaiming power from those who abuse it often starts with telling the truth. And in "This Is How Authoritarians Get Defeated," MoJo's Monika Bauerlein unpacks six truths to remember during the homestretch of an election where democracy, truth, and decency are on the line.

Truth #1: The chaos is the point.

Truth #2: Team Reality is bigger than it seems.

Truth #3: Facebook owns this.

Truth #4: When we go to work, we're in the fight.

Truth #5: It's about minority rule.

Truth #6: The only thing that can save us is…us.

Please take a moment to see how all these truths add up, because what happens in the weeks and months ahead will reverberate for at least a generation and we better be prepared.

And if you think journalism like Mother Jones'—that calls it like it is, that will never acquiesce to power, that looks where others don't—can help guide us through this historic, high-stakes moment, and you're able to right now, please help us reach our $350,000 goal by October 31 with a donation today. It's all hands on deck for democracy.

payment methods

We Recommend

Latest

Sign up for our free newsletter

Subscribe to the Mother Jones Daily to have our top stories delivered directly to your inbox.

Get our award-winning magazine

Save big on a full year of investigations, ideas, and insights.

Subscribe

Support our journalism

Help Mother Jones' reporters dig deep with a tax-deductible donation.

Donate