How about harm reduction for the poor? | Editorial

As the opioid epidemic has progressed, the policy of harm reduction – strategies to reduce the harm of drugs rather than demonizing the users — has been at the center of debates about how to address the crisis. We wish that lawmakers would start applying the concept of harm reduction to their approach to their low-income constituents.

Instead, a number of proposals seem designed to cause as much harm to struggling people as possible.

>> READ MORE: My patients are kids caught in the middle of the opioid crisis. Who speaks for them?

For example, every year, the predatory loan industry makes a run at eroding the protections that Pennsylvania provides when it comes to lenders' ability to impose high fees and interest rates on those who don't qualify for conventional loans.  These efforts have come to resemble an annual whack-a-mole: In years past, lenders have tried to remove interest rate caps, soften regulations for debt settlement companies, and lower the barriers for allowing lenders to operate their usurious practices in the state.  They and their legislative sponsors typically claim that these proposals strengthen consumer protections, when they do the opposite.

This year, House Bill 2429 sponsored by Doyle Heffley (R., Carbon) would allow payday lenders to pose as loan brokers in order to charge unlimited fees and make sky-high interest rate loans.  Lenders pose as brokers under state credit repair or credit services organizations and arrange predatory loans.  Those brokers charge high fees that don't get considered interest, thereby skirting laws.

That's bad enough. But there's even more harm coming down the pike: Lawmakers want to impose work requirements for Medicaid recipients.  The Trump administration is urging states to apply for waivers that would allow such requirements; Pennsylvania's work requirement bill could be up for a vote in the Senate.

>> READ MORE: I'm homeless. SNAP and Medicaid have been my lifesavers. | Opinion

Those too poor to afford health coverage – often the chronically ill and the disabled – will be required to show proof that if they are not working, they are at least looking for work.

This idea is shortsighted on many fronts: For example, what happens to people who get jobs and then become ineligible for Medicaid, but still can't afford health coverage? That could mean becoming too sick to work.  What about the huge administrative costs that will be associated with having to check and confirm employment status; in Pennsylvania alone, nearly three million people receive Medicaid. The requirements would exempt certain categories such as the elderly (those older than 64) and caregivers, but those who have chronic medical conditions would not necessarily be exempt. It could also force students who are trying to advance their education to drop out to get a job.

The belief that people would rather be idle just to scam the government out of free health care, get those generous food stamp allowances ($192 a month for an individual), and get lucrative welfare payments (nonexistent for the last 20 years)  refuses to die.

Not everyone agrees with harm reduction policies for opioid users; surely, though, low-income people with precarious options for family-sustaining employment should be entitled to laws that don't add harm, misery and illness to their lives.