Lessons from History: Why Some Ideas Remain Bad Choices Over Time

With the recent federal changes brought by H.R. 1, I see elements of the past. This isn't just reminiscent of Oregon's missteps in healthcare policy following the 2008 recession, but rather echoes a much older, problematic time. The components of H.R. 1 are strikingly similar to the English Poor Laws of the 1840s—think Charles Dickens. These arcane laws were rooted in moral judgment, dividing the 'deserving' poor from the 'undeserving' able-bodied poor.

The underlying assumption was that some people are simply lazy and must be compelled to work, or else face punishment, incarceration or life in a poorhouse- indentured servitude. Exclusions were made for some elderly and those with visible disabilities, but the system still relied on arbitrary distinctions. Today, we are attempting to mask these old 'moral judgments' with the veneer of a technocratic policy.

The reality is that the work requirement instituted in Arkansas as part of its Medicaid expansion, and Georgia, hasn't worked. People were not kicked off Medicaid because they weren't meeting their work requirements. It's because of the bureaucracy, for example, not submitting a timely change of address notice, or being able to work 40 hours in one month but 100 and another if you’re seasonally employed, didn't count. It was more difficult for people living in remote rural areas with poor Internet access to report their employment or education hours. Exemptions were for a person is in a substance treatment facility, but not if they were seeking psychiatric residential treatment; in other words, an addiction was permissible, but a mental health condition was not. If you have a disability but have not been approved by the Social Security Administration (which is backlogged sometimes up to a year). We have inconsistencies and lack clear due process.

In those two states, there was no big increase in employment. There were increased administrative costs, and (drum roll) a lawsuit stopped it because it was arbitrary and capricious - (too unpredictable and random).  Many people were simply kicked off of Medicaid, and their healthcare needs were not met- shifting cost to hospitals and clinics for uncompensated care .  This means EVERYONE’s health care costs will increase, public, private, employer-sponsored, and Medicare and access reduced.

Ultimately, the policy options before us are repeating the mistakes of the past. Oregon

was asked to spend $200 million on information technology upgrades and hire 25 additional staff—not to improve care, but to check eligibility every six months rather than every 24 months—to create pointless bureaucratic hurdles. The real objective is not efficiency or fairness; it is to quietly remove people from Medicaid rolls and provide political cover for those making these decisions. We should learn from both history and recent state experiences: such policies do not promote work or save money, but instead harm vulnerable communities and shift costs elsewhere. In Oregon, with the highest percentage of people in rural areas on Medicaid and poorer internet access- those parts of the state- will be hardest hit.

Oregon has an opportunity to reject this false choice and invest in policies that truly improve health and well-being for all residents. I suggest we challenge these steps and invest in what will help improve the health and well-being of Oregonians - the Oregon Way.