In a recent article titled “This Law makes me ashamed of my country,” former Harvard President and Treasury Lawrence Summers detailed the cruelty of humanity, which will be attributed to the unprecedented cuts to Medicaid. One obvious omission in his striking narrative is the attention of 3.4 million college students who are estimated to be Medicaid recipients.
Especially those with disabilities and those with chronic illness, including mental health issues, have recently gone beyond financial considerations because students either drop out of school first or do not attend. Additionally, when states face budget shortages, higher education is often one of the earliest areas of targeting, resulting in higher tuition fees, less resources for students, and cut academic support services. To be sure, reducing state-funded grants will have a direct negative impact on the college visits and quality of approximately 13.5 million students attending U.S. community colleges and public universities. Disastrous effects include exacerbating existing health care disparities in rural and underserved communities.
Furthermore, poor health and financial insecurity are known to significantly reduce cognitive bandwidth, hindering students’ ability to learn and lead to reduced completion rates. Racism, sexism, homophobia, ability and other forms of discrimination all lead to reduced cognitive bandwidth. Research shows that attribution uncertainty is one of the largest bandwidth stealers. Since the passage of the A Large Bill, I have been unable to stop considering the long-term consequences of those who already doubt whether they belong to college.
My understanding of the subtle and powerful ways in which policy and practice convey exclusion is not merely an exercise in moral imagination, but at the heart of my life experience. When I started college at the age of 17 and was a first-generation student, I was able to escape the factory work I had done with my mother the summer before, just because I received funding under the Comprehensive Employment and Training Act. At that time, CETA funds were reserved for people with the lowest socio-economic range, who were considered at risk of permanent unemployment. That fall, with the extra help from the Pell Grant and Perkins loan, I attended a local community college that just opened in the small town where I live. During my first two years at university, I worked 35 hours a week under a CETA contract, completed all five classes per semester, and worked as a nursing staff for my mother, who was ill for a long time. Like my mother, I have severe asthma, which can be treated on days with biologics and inhaled corticosteroids, and Medicaid is the lifeline for both of us.
Later in the afternoon, I rushed to town from the pharmacy at the American Literature class in the basement of the Congregational Church, trying to teach in a public high school a few hours later before heading to my Bio 101 lab. My communication with the pharmacist came directly from the Monty Python short play. Someone was walking around, browsing the makeup aisle and buying toiletries, but nothing else except that I picked up the prescription. But when I handed over my Medicaid card, the control yelled at the drug users was enough to make everyone hear “Title XIX patients lined up over there.” Whatever his intentions, the pharmacist insisted that I was at the wrong line and that I went on a different, non-existent line, and that I was actually the person in any line, and that he was the only person behind the counter, not just blindly insisting on meaningless bureaucratic agreements, which is a rename of the wealthy people of all but the wealthy people of society. Students who are already uncertain whether they belong to college start internalizing their existence on campus that is conditional and tolerant.
When state leaders use Medicaid as a “right” and abuse taxpayer’s money, their rhetoric conveys a sense of stigma and the appropriateness of shame for those who rely on it. I’m particularly concerned about the impact of stricter Medicaid job requirements on people in communities like me, with limited job opportunities and few public transportation. The recent cuts to Medicaid sent them a message that their struggles were either invisible or insignificant.
The new Medicaid policy is not an accidental mistake. They are a social policy ecosystem that aims to enjoy the privileges of certain people while getting rid of others. So when we see Medicaid cuts and rollbacks in programs like SNAP (Supplementary Nutrition Assistance Program), we need not only to understand them as budgetary decisions, but also as intentional exclusion reinforcement. Indeed, Medicaid cuts are more than just removing health care, they weaken social contracts, saying everyone deserves education and well-being. Rather than reaffirming higher education as the cornerstone of the American Dream with a minimum socio-economic range for students, it is better to say that the message from cuts to Medicaid is clear: If you are poor, you will not belong to a university. Higher education is reserved for those who do not need help or stay there.
As Jessica Riddell, an American Association of Members of the University and University Committee, reminds us, “The system of higher education has been broken and the system is operating as designed.” Therefore, higher education advocates at all levels must organize, teach and lead in a way that dismantles the design.
