One of the most common healthcare proposals from the GOP is to give Medicaid over to the states. It was one of the central themes of Trumpcare. The theory, such as it is, is that the states will do a better job overseeing Medicaid and would be able to alter it to suit the state’s individual needs. Of course, there’s a reason the Feds were minding the store when Medicaid was first created and should resume doing so.

Many states no longer believe in Medicaid

One of the things about the modern GOP is that they’re basically Libertarians with some stuff abortion and gay marriage thrown in. A good number of the GOP states would just as soon dismantle Medicaid in its entirety and hope that churches and charities will somehow pick up the slack. The notion that this has any chance of working ignores two key things.

First off, churches would be quickly overwhelmed. Caring for people with complex medical conditions is neither a cheap nor simple task. There is already a shortage of skilled nurses providing in-home care. If Medicaid goes away, those nurses, being paid primarily by Medicaid, will simply change careers.

Rural areas are the second reason ending Medicaid is a terrible plan. There’s a reason that much of the New Deal was focused on rural America. Big charities weren’t operating there then. Most fraternal organizations were focused on urban America. Churches in these areas were overwhelmed during the Depression. This would repeat if Medicaid were to go away.

Furthermore, with young people leaving rural America in record numbers, ending Medicaid, and the in-home care it provides, would be catastrophic. Young people may not be able to give up their job and rush back home to take care of an ailing relative. Ailing relatives on fixed incomes most likely won’t be finding an accessible house near relatives able to care for them. That’s the beauty of Medicaid in-home care services: They allow people to live their lives.

Technology won’t save us either. People will point to GoFundMe and other crowdfunding sites. However, most medical crowdfunding attempts fail. In order to succeed, you basically need to be adorable, have a disease that people find sympathetic and have connections to news media and/or celebrities. If Medicaid goes away, this would get out of control.

Consider MCO’s and education lotteries

There is another reason the Feds kept tight tabs on Medicaid. They did it to make sure Medicaid money got to the people who needed it. Ever since the Feds have been taking a more hands-off approach to Medicaid, several states have contracted out Medicaid to for-profit Managed Care Organizations, many of whom have raided the Medicaid funds for their profit while cutting funds for those who need them. Cardinal Innovations of North Carolina was one such MCO but there are many others across multiple states. Every single one of which is an argument for the Feds tightening the leash.

If you want another reason to keep Medicaid in Federal hands, look at education lotteries. In theory, the money is supposed to bolster education funding. In practice, these funds routinely get raided for other projects. Sometimes the state cuts education funds by the same amount the lottery raises, making the lottery pointless. This is true in both red and blue states.

If the Feds got out entirely, Medicaid funds would most likely be raided in the same fashion. However, it gets worse from here.

Medicaid now being used for partisan retribution

Recently, the White House has authorized states to impose work requirements and has thus far made no indication that they’re willing to make sure said requirements are applied fairly. What has resulted is three red states imposing work requirements on Medicaid recipients in Democratic voting areas, while exempting Medicaid recipients in areas that went Republican. There is no telling how many more states will be inclined to do the same if allowed to do so.

There’s also no telling if Democrats won’t do the same thing to Republican areas. The notion of “When they go low we go high” is a dying one in many left-leaning circles. As far as a lot of them are concerned, they tried going high and it didn’t work. Statements like “If right-wingers hate socialism so much, maybe they shouldn’t be allowed to apply for (insert program the far-right says is socialism here),” are becoming more common among the base. Anyone who thinks the Dems would be above using Medicaid work requirements to punish regions that vote against them is simply being naive. The GOP opened the door to using Medicaid for partisan punishment. It will be entered when the pendulum swings.

And that was one of the reasons the Feds minded the store to begin with. They made sure that sick, disabled, elderly and the poor got healthcare regardless of which party they voted for. Now that state legislatures are not being monitored, they are turning Medicaid into a vehicle of partisan vengeance. The only way to prevent this is for the Feds to return to being the adult in the room and make sure Medicaid recipients aren’t punished for voting for an opposing party.

Disability does not discriminate

It is impossible to escape disability. You may have been born with one. You may have a kid with one. Chances are, you’ll get one as you get older. Being responsible, taking care of yourself, etc. only delays the inevitable. There’s a reason the Americans with Disabilities Act says that “Disability is a natural part of the human experience.”

Everybody, whether you’re Democrat or Republican, urban or rural, socialist or anarcho-capitalist, is one bad day away from disability and needing Medicaid services of some type. There is only so much churches and families can do. And unless you’re uber-rich, no plan you concoct will allow you to bootstrap it. Medicaid, warts and all, provides a lifeline to people who don’t have friends and family who are able to care for a sick person full-time. We need the Feds to make sure Medicaid isn’t raided by corporate vultures or used as a tool of retribution by partisan extremists.