As states start to take advantage of the Trump Administration’s invitation to strip Medicaid coverage away from millions by imposing restrictions such as ‘work’ requirements designed to reduce access to coverage, these proposals face a wave of backlash from local editorial boards, lawmakers, health care providers, hospitals, and advocates:
Iowa (legislation to impose work requirements introduced in Feb. 2018)
Des Moines Register editorial: Medicaid bill demonizes low-income Iowans with delays, drug tests, work requirements. Iowa state Sen. Tom Greene, R-Burlington, is sponsoring Senate File 2158, a measure which “directs the Iowa Department of Human Services to seek federal approval to impose work requirements on Medicaid recipients.” The paper adds, “One would think Greene, who worked as a pharmacist for four decades, would understand the importance of ensuring Iowans get care needed to be productive members of society. Then again, the part-time lawmaker was not required to pee in a cup or wait six months to enjoy his taxpayer-subsidized family coverage.” [Des Moines Register, 2/14/18]
Louisiana (expected to propose work requirements in mid-Feb. 2018)
Republican state lawmaker skeptical: “Medicaid work requirements probably would not save much money as the state tries to close a looming $1 billion budget shortfall, he added. Louisiana legislators have expressed similar concerns. ‘I’m skeptical that it’s going to be any real savings,’ said Rep. Kirk Talbot, R-River Ridge.” [Louisiana Daily Comet, 2/6/18]
West Virginia (considering Medicaid work requirements as of Feb. 2018)
Charleston Gazette-Mail editorial: Work requirements don’t help people work. “Helping people achieve gainful employment and self-sufficiency is exactly the right goal. Disrupting people’s health coverage will not accomplish it. Medicaid recipients already struggle to maintain employment and support themselves. Otherwise, they wouldn’t qualify for Medicaid…A smarter, not to mention more humane, approach would be to remove as many barriers to health care access as possible for the state’s most challenged residents. The smarter approach would be to err on the side of inclusion. Cover more West Virginians, and don’t hassle them off of Medicaid month after month as their work status fluctuates.” [Charleston Gazette-Mail, 1/25/18]
Missouri (state has called for legislation to pursue work requirement)
St. Louis Post-Dispatch editorial: Job requirements for Medicaid recipients won’t work and might actually backfire. “Tracking down these people will require state governments to expand their staffing to police the work requirement and administer the paperwork. If the work requirement is similar to that required for coverage under the Temporary Assistance for Needy Families program, child care and transportation will have to be subsidized if it’s available. The cost savings for taxpayers is starting to look a little hazy…Ironically, researchers say that taking health insurance away from people makes it less likely they will be able to get and keep a job. This will be particularly true if, as expected, the burden of the work requirement falls most heavily on those with physical or mental impairments not yet certified as permanent disabilities.” [St. Louis Post-Dispatch, 1/15/18]
Missouri family medicine physician: Rolling back Medicaid will worsen Missouri’s opioid crisis. “For Missourians struggling with opioid addiction, Medicaid is the difference between life and death. The medications I prescribe can help 50 percent of patients begin recovery and stay healthy in the long term. With access to these medications, I see many of my patients rebuilding their lives, advancing in their careers and enjoying life with their families. But without Medicaid, many will lose access to the treatment and medications that we know are effective. Even for those with full-time jobs, many Missourians simply don’t make enough to afford private health insurance, and Medicaid is their only option to afford health care.” [Columbia Missourian, 1/31/18]
Maine (work requirement submitted for approval on 8/2/2017)
Portland Press-Herald editorial: Medicaid limits are not what Maine voters want. “MaineCare is health care, not welfare. People on the program don’t get a check every month that discourages them from working. But they do get a chance to go to see a doctor when they are sick, or fill prescriptions that keep chronic diseases at bay. Adding more hurdles to applying for benefits will inevitably result in eligible people failing to be enrolled. The bureaucratic nightmare of trying to figure out who has received how much coverage during their lifetimes would slow the process for everyone … Cutting off someone’s health care is not going to make them more likely to work — just the opposite is true. Illness is one of the main barriers that prevents people from working.” [Portland Press Herald, 2/8/18]
Bangor Daily News editorial: The contorted logic of allowing states to require work as a condition for Medicaid. “If work requirements in a food assistance program are likely to lead to a diminished state of health for thousands of low-income adults, it’s not hard to imagine the damaging health effects of imposing work requirements in a benefit program designed explicitly to ensure that the poorest among us can access health care.” [Bangor Daily News, 1/19/18]
South Dakota (Gov. Dennis Daugaard has called for Medicaid work requirements)
Yankton Daily Press & Dakotan editorial: Be wary of what’s lurking in the details of Medicaid work requirements. “The statement also feeds the long-held generalization embraced by some people that many of those receiving some form of low-income assistance are basically living off the government dole instead of working. However, a lot of low-income people who receive Medicaid are already working but aren’t able to make ends meet or afford basic health care, which Medicaid helps provide…If handled properly, the work requirement for Medicaid proposed by Daugaard — and pushed by the White House — may impact only a small segment of recipients. If this move becomes something more than that — which, unfortunately, could be vaguely implied by Verma’s blunt remarks — then the idea may be little more than subterfuge for something else.” [Yankton Daily Press & Dakotan, 1/20/18]
Kansas (work requirement submitted for approval on 12/20/2017)
Health execs: Don’t equate work requirements with job stability. “‘If the state is going to make further changes to the KanCare program, it will put a greater burden on the state’s general fund, hospitals and providers, said Brenda Sharpe, CEO of the REACH Healthcare Foundation. ‘The misconception of who is on Medicaid is rampant.’ Sharpe also said the proposed changes fail to account for the type of jobs most low-income workers hold. For example, a construction job may be seasonal, and a retail worker’s schedule may very week by week — then throw in the need for child care. ‘If they lose their job for three months because they work in an outdoor setting, are you going to kick them off benefits for three months?… The best thing you can do to get someone to keep a job is to give them health insurance.’” [Kansas City Business Journal, 1/24/18]
Arizona (work requirement submitted for approval on 1/4/2018)
Arizona Alliance for Healthcare Security: “They have no evidence of anyone taking advantage of the system, so this just becomes another obstacle for people to overcome in order to get Medicaid benefits.” [Inside Tucson Business, 1/19/18]
Arkansas (work requirement submitted for approval on 6/30/2017)
Arkansas Advocates for Children and Families: “Arkansas Works, the state’s Medicaid expansion program, has successfully provided hundreds of thousands of Arkansans with affordable health care coverage and has saved the state money in charity payments to providers for uncompensated care. But the proposed changes are designed to remove people from coverage without giving them a comparable alternative. This is not just bad policy – it runs counter to Medicaid’s core mission of providing health care coverage to low-income people.” [AACF report, 1/4/18]
Kentucky (work requirement approved on 1/12/2018)
Lexington Herald-Leader editorial: Cutting unemployment benefits won’t strengthen Ky. workforce. “The best hope for addiction treatment is Medicaid, but the state is getting ready to impose new work requirements and other hurdles to treatment and the chance at a responsible life.” [Lexington Herald-Leader, 2/14/18]
Policy analyst: “You’re spending more money to cover fewer people.” “Cost savings come from the assumption that nearly 100,000 people will drop out of Medicaid by the end of the five-year project recently approved by the federal government. For those who remain, the monthly cost of care increases faster than it would have had the state made no changes, according to the administration’s projections. ‘You’re spending more money to cover fewer people,’ said Dustin Pugel, a policy analyst for the Kentucky Center for Economic Policy in Berea and a critic of the Bevin plan. I’m not crazy about the idea of us spending more money to cover fewer people.'” [Louisville Courier Journal, 2/14/18]
Indiana Daily Student editorial: Kentucky’s Medicaid requirements hurt more than help. “There are patients on Medicaid who are disabled, need cancer treatment and have other situations that would make working impossible or incredibly difficult.” [Indiana Daily Student, 2/5/18]
Utah (work requirement submitted for approval on 8/16/2017)
Op-ed: Medicaid ‘work mandate’ is misguided policy. “The 1115 waiver’s “work requirement” is a fancy term for ‘work mandate’; it is in fact designed to provide less coverage overall. Utah children and parents will be caught in a poverty cycle. Utahns will be far less healthy than they would be with full Medicaid expansion through the Utah Decides ballot initiative.” [Utah Policy, 1/11/18]
Wisconsin (work requirement submitted for approval on 6/15/2017)
Policy analyst: “Requiring you to work to get healthy — there’s something backwards there.” “‘If you’re not healthy, it’s difficult to work,’ said Mike Bare, research director for Community Advocates’ Public Policy Institute in Milwaukee. ‘Requiring you to work to get healthy — there’s something backwards there.’” [Wisconsin State Journal, 1/11/18]
Madison nonprofit: Work requirements only make lives harder. “‘This is targeted at the lowest-income folks that we have out there, people who have difficult lives already,’ said Bobby Peterson, executive director of ABC for Health, a nonprofit public interest law firm in Madison. ‘We’re just making it harder for them.’” [Wisconsin State Journal, 1/11/18]
Illinois (Rauner administration developing Medicaid work requirement)
Shriver National Center on Poverty Law: A Medicaid work requirement would be cruel — and costly. “Medicaid work requirements will largely be used to punish people in dire need for forces beyond their control…Ironically, by taking crucial medical assistance away from people who are already struggling, work requirements will make finding or maintaining employment much more difficult. The fact of the matter is that Medicaid, like most other major anti-poverty programs, serves as a work support.” [Chicago Tribune, 1/23/18]
Ohio (Kasich administration preparing to submit application)
Ohio Center for Community Solutions: “To suddenly remove these resources not only dis-benefits this huge area of employment and this huge area of economic impact for providers and others, it would have drastic impacts on things like the opioid epidemic, on chronic-disease management.” [Cleveland Scene, 2/12/18]
South Carolina (McMaster administration has directed Medicaid agency to submit application)
South Carolina Hospital Association VP: “If anything, we should help them get the care they need so they can return to work and lead more fulfilling lives.” “After all, most Medicaid beneficiaries in South Carolina are already working. Among those who are not, 52 percent are disabled or too sick, while another 32 percent act as caregivers. Community-engagement requirements shouldn’t punish the sick or discriminate against those with disabilities; if anything, we should help them get the care they need so they can return to work and lead more fulfilling lives.” [The State, 2/7/18]
Tennessee (House speaker has filed Medicaid work requirements bill)
TennCare Work Plan Would Affect 86K, Cost $18.7M. “A state analysis says legislation seeking to require certain able-bodied TennCare recipients to work, volunteer or attend school would affect 86,400 people and cost the state $18.7 million annually…The $18.7 million net cost notably includes $22.3 million more in anticipated case management state costs and $3.7 million in estimated state savings from disenrollments, assuming a 2020 program start.” [U.S. News & World Report, 2/14/18]
Chattanooga Times Free Press: Nearly 87,000 adult TennCare enrollees could be affected under work requirement plan. “As many as 86,400 able-bodied adult enrollees on Tennessee’s Medicaid program could be affected by a bill that seeks to require they work, attend school, volunteer or face losing their health benefits, according to a legislative analysis … Rep. John Ray Clemmons, D-Nashville, said ‘the data is clear’ with proponents’ ‘ultimate’ goal being ‘to kick people off’ of TennCare, the state’s Medicaid program.” [Chattanooga Times Free Press, 2/14/18]
… and 160 National, State, and Local Organizations Oppose Work Requirements in Letter to Secretary Azar: “CMS’s Medicaid work requirements policy is directly at odds with bipartisan efforts to curb the opioid crisis .. and will have a significant and disproportionately harmful effect on individuals with chronic health conditions, especially those struggling with substance use disorders (SUDs) and mental health disorders.” [2/15/18]
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