There's another factor here: There's a huge swath of services that private insurance companies outright will not, under any circumstances, cover. They are explicitly exempted from having to cover these things specifically because they are technically available through Medicaid. This very much includes critical things like long-term caregivers/assistive devices. So having access to Medicaid becomes extremely important as soon as you need any of those services.
His supervisor was given a $20k bonus with a performance review that specifically cited that "Don Sanders is no longer working for BNSF." Insane that there are no criminal penalties for this nonsense, just penny fines absorbed by the company.
The culture doesn't allow it. If you don't publish enough, in prestigious enough journals, instead of tenure you get replaced. That's one reason this is a pretty interesting move - by providing an alternative publishing location based on principles that the universities supposedly value, this sort of departure _could_ help push the academic culture toward a less-abusive publishing model. Institutional change is hard.