COUNTERPOINT: Should Medicaid recipients have to work for benefits?
No. Imposing such restriction is costly and threatens program
By MADELINE TWOMEY
At the beginning of 2018, the Trump administration announced that it would allow states to impose so-called work requirements on Medicaid recipients, issuing guidance on how state officials can utilize federal waivers to incentivize “work and community engagement activities.” These activities typically include employment, volunteering, or enrollment in educational programs.
Although this type of reform may sound reasonable, imposing these restrictions are costly and actually threaten to increase the number of uninsured people and impose strict barriers to health care for the people already struggling to make ends meet.
Still, this decision thrilled many Republican lawmakers across the country, who have long supported these types of requirements. These conservatives continue to push false stereotypes about Medicaid to argue that the program is wasteful. Indeed, the decision to impose Medicaid work requirements is not a genuine effort to help individuals find work, but ultimately to impose additional barriers that decrease enrollment in and cut spending from the program.
The Administration’s efforts illustrate yet another partisan attack on health care. President Trump has worked tirelessly to dismantle the Affordable Care Act, and his administration has targeted the law’s expansion of Medicaid in particular. It is clear that the Trump administration is seeking to strip essential health coverage from vulnerable individuals, especially among those who gained Medicaid coverage under the ACA.
There is almost no evidence to support that work requirements will actually help fight poverty. In fact, work requirements are largely counterproductive to promoting health and employment. According to the nonpartisan Kaiser Family Foundation, six of 10 non-elderly Medicaid beneficiaries are already working. Many of these individuals work in low-wage jobs that do not offer health coverage. Among those who aren’t working, most report significant barriers to finding stable employment, such as caregiving responsibilities or illness.
In reality, imposing work requirements will result in steep coverage losses. Many of these proposals include harmful lockout periods that will prevent individuals who lose Medicaid coverage from re-enrolling if they fail to properly document their qualifying activities. For example, Arkansas’ waiver allows for lockout periods of up to eight months for individuals who fail to report their work or regularly claim exemptions.
Even Medicaid beneficiaries who are working are likely to find it difficult to navigate the new paperwork and red tape created by the work requirements. That’s why the Kaiser Family Foundation estimates that most of the beneficiaries who lose their coverage due to work requirements will actually be people who have jobs or should be exempt from the requirements, but who will get tripped up by the onerous paperwork.
Strict paperwork requirements will especially impact individuals in rural areas where Internet coverage could serve as an additional barrier to receiving Medicaid coverage. In Arkansas, for example, Medicaid beneficiaries will only be able to submit documentation for work requirements online, even though the state has the second-lowest rate of Internet access in the country.
Of course, the resulting coverage losses will inevitably lead to worsening health outcomes. Insurance coverage across all populations is a key predictor of good health. Medicaid recipients are already more likely to have chronic conditions and suffer from poor health. As these individuals lose health coverage due to work requirements, they will be less able to afford medical care and subsequently at higher risk of getting sick. This won’t just be harmful to their health – it will also make it much harder for them to maintain a steady job. For this very reason, Medicaid expansion under the ACA has proven to improve low-income people’s’ overall financial security.
This will particularly hurt individuals with disabilities who do not receive Social Security benefits — nearly 5 million people — and who may fail to qualify for exemptions despite facing serious illnesses. These aren’t the only individuals disproportionately threatened by work requirements: Michigan’s initial proposal, for example, would have exempted individuals in mostly white, rural areas where unemployment is high. As a result, work requirements would have disproportionately affected people of color in the state. While this exemption was ultimately removed, it illustrates the subjective nature of these proposals.
Work requirement waivers have so far been approved in Arkansas, Indiana, New Hampshire, and Kentucky; however, a federal district judge recently struck down Kentucky’s proposal, finding that HHS Secretary Alex Azar’s approval of the state’s program was “arbitrary and capricious.” The judge specifically pointed to the 95,000 Kentucky residents who were at risk of losing coverage under these new requirements.
Despite legal challenges and criticism from health-care experts, lawmakers in other states are largely moving forward without changes to their waiver programs. In June, Arkansas became the first state to enact its work requirement program. Unsurprisingly, initial research shows that among the 22,000 qualifying Arkansans, nearly 7,500 did not meet the work requirements and are at risk of losing coverage. Indiana and New Hampshire’s requirements are expected to go into effect on Jan. 1, 2019, and waivers are still pending in seven states who seek to impose similar requirements.
Unfortunately, conservative lawmakers haven’t limited their Medicaid sabotage to work requirements. With the encouragement of the Trump administration, states are imposing premiums on beneficiaries, raising cost-sharing, and seeking to reduce benefits. Illinois and other states should not waste time considering imposing work requirements. Instead of using taxpayer dollars imposing unnecessary barriers to Medicaid recipients, lawmakers should be looking to protect health care access for those who need it most.
Madeline Twomey is the special assistant for health policy at Center for American Progress. She wrote this column at the request of the Illinois Business Journal.