Medicaid

Today, the Trump Administration announced changes to Medicaid, the nation’s largest health insurance program. Issued to mandate work requirements to those receiving Medicaid, the proposed changes jeopardize health care for millions of Americans – nearly all of whom are already working. Responses to this announcement have focused on the amount of unnecessary suffering this could bring about, as well as the vast mistruths the Trump Administration is promoting. Don’t believe us?  Take a look for yourself…

Politico: “Independent studies have shown that most Medicaid enrollees who are eligible to work already do so.” [Politico, 1/11]

Washington Post: “Most health policy experts, including a few noted conservatives, have regarded the government insurance enabling millions of people to afford medical care as a right that should not hinge on individuals’ compliance with other rules.” [Washington Post, 1/11]

Vox: “Republicans argue that requiring work for Medicaid eligibility will lead to better health outcomes, because employment can be linked to improved health and help move people off Medicaid as they make more money. But many Medicaid recipients are already working. If they are not, then they are likely elderly, disabled, retired, sick, or caring for a loved one. These new bureaucratic hurdles could impede some Americans’ ability to access health insurance and the care they need.” [Vox, 1/11]

Los Angeles Times: “Critics of the Trump administration’s approach note that a growing body of evidence shows that Medicaid health coverage is helping many Americans improve their health and their finances, not holding them back, as Verma and other have suggested… There is little evidence that many working-age Medicaid enrollees are choosing the government coverage instead of seeking work.” [Los Angeles Times, 1/11]

CNN: “The Trump administration is about to start letting states require many Medicaid recipients to work for their benefits. But millions of Americans in the health care safety net program already have jobs. Some 60% of working age, non-disabled Medicaid enrollees are working, according to a new report from the Kaiser Family Foundation. That’s about 15 million people. Plus, nearly eight in 10 recipients live in families with at least one worker.” [CNN, 1/11]

Associated Press: “Most who are not working report reasons such as illness, caring for a family member or going to school. Some Medicaid recipients say the coverage has enabled them to get healthy enough to return to work.” [NBC News, 1/11]

Washington Examiner: “A Kaiser Family Foundation brief about work requirements in other programs, such as SNAP and TANF, raised questions about their effectiveness in getting people employed and said states spend a large amount of time and money making sure the requirements are followed.” [Washington Examiner, 1/11]

USA Today: “Health groups and advocates for the poor — including the National Center for Law and Economic Justice and the American Lung Association — dispute Verma’s contention that the Centers Medicare and Medicaid Service has the authority to grant such requests. Courts have said states can’t add additional requirements for Medicaid eligibility that are not in law, the coalition wrote. Some bills offered in Congress address such changes, but haven’t passed yet. ‘Most people on Medicaid who can work, do so,’ the coalition wrote, ‘and for people who face major obstacles to employment, harsh requirements won’t help them overcome them.’” [USA Today, 1/11]

Harold Pollock, University of Chicago: “Medicaid work requirements may hit Trump country hardest. They could hit underemployed early-retirees who now find themselves reliant on Medicaid.. They could hit surprising numbers of people with disabilities — including addiction to opioids — who are covered under the ACA Medicaid expansion but can’t fill the requirements. They could hit hospitals in low-income rural areas that provide services to people who have lost Medicaid and can’t pay.” [Washington Post, 1/11]

Jeff Grogger, University of Chicago: “Medicaid, unlike cash welfare payments, isn’t a disincentive to work, because it doesn’t provide people with funds they’d need to pay rent or buy food, said Jeff Grogger, an urban policy professor at the University of Chicago. He said it’s not clear what problem a Medicaid work requirement would solve, and that there are better ways to help people find jobs or reduce the number of people receiving Medicaid.”

Jeff Grogger, University of Chicago: “It’s not like Medicaid is providing some kind of alternative lifestyle that’s attractive and keeps people out of the workforce. If we had fewer sick people and fewer poor people, that’d lower the Medicaid rolls. Thinking in those terms is more productive.” [Bloomberg, 1/11]

Sara Rosenbaum, George Washington University: “‘It’s like the Wild West. Who knows what will come in the door?’ Sara Rosenbaum, a George Washington University professor who has followed Medicaid policy for decades, said. ‘Everything is couched as ‘you could,’ ‘you might,’ ‘you should think about.’ It’s like winking and nodding throughout the whole thing. They are not saying, ‘These are the limits on what we’ll approve.’” [Vox, 1/11]

Sara Rosenbaum, George Washington University: “There is a breathtaking lack of guardrails. Basically almost anything goes.. There’s really nobody who’s exempt.” [Vox, 1/11]

Elliot Fishman, Former CMS Administrator: “You’re going to lose not just the people who don’t meet the requirement but also those who can’t get through the new bureaucratic process.. Our experience over decades of research is that any time you require new documentation, you lose a lot of people who in principle shouldn’t be losing eligibility.” [Talking Points Memo, 1/11]

Elliot Fishman, Former CMS Administrator: “The requirement for Medicaid waivers is that they promote the objectives of the Medicaid program, and not just in the Obama administration, but in every previous administration, that was always understood to mean expanding coverage and strengthening the delivery of medical services. It has never been used to just cut back on coverage, which this is an effort to do.” [Talking Points Memo, 1/11]

Leonard Cuello, National Health Law Program National Policy Director: “Cuello said the argument that work promotes health is ‘totally contorted . . . It’s a little like saying that rain causes clouds. It’s more that people [with Medicaid] get care, which helps them be healthy and makes them able to work.’” [Washington Post, 1/11]

Mary Beth Musucemi, Kaiser Foundation Medicaid and the Uninsured Program Associated Director: This “will penalize individuals by having them lose health coverage, rather than incentivize them, as a voluntary program with adequately funded supportive services necessary to overcome barriers would.” [Washington Post, 1/11]

Mary Beth Musucemi, Kaiser Foundation Medicaid and the Uninsured Program Associated Director: “Conditioning Medicaid eligibility and coverage on work is a fundamental change to the 50 plus year history of the Medicaid program… There is a real risk of eligible people losing coverage due to their inability to navigate this process or miscommunication or other breakdowns in the administrative process.” [The Hill, 1/11]

Joan Alker, Georgetown Center for Children and Families Executive Director: The administration “has the ‘causality backwards’ and ‘you’re more likely to be able to work’ if you have health insurance such as Medicaid in the first place.” [The Hill, 1/11]

Matt Fiedler, Brookings Institution: “Documenting compliance will often not be trivial, and even small hassle costs can discourage people from signing up for insurance coverage… Higher hassle costs will likely cause meaningful reductions in Medicaid coverage even among people who are working.”  [Vox, 1/11]

Eliot Fishman, Families USA Senior Health Policy Director: “Unconscionable and illegal… Today’s announcement isn’t about work. It is about taking away health insurance from low-income people.” [Washington Post, 1/11]

Judy Solomon, Center on Budget and Policy Priorities Vice President for Health Policy:  “It is a very major change in Medicaid that for the first time would allow people to be cut off for not meeting a work requirement, regardless of the hardship they may suffer… There’s never been a work requirement in Medicaid, it’s only been in recent years that states have raised the possibility of having one. Medicaid is a health program that is supposed to serve people who don’t otherwise have coverage.” [NBC News, 1/11]

Judy Solomon, Center on Budget and Policy Priorities Vice President for Health Policy: “Don’t be fooled by the new [CMS] guidance saying will protect people with disabilities. It won’t. While people who get Medicaid because they meet strict Social Security disability criteria are exempt, there are lots of people who are ill or have a disability who get Medicaid. These people including people with cancer, mental illness and substance use disorders, will be subject to the work requirement and have to prove they are exempt with a doctor’s letter or other proof. Many won’t know to do that and some won’t be able to get the paperwork… The consequences will be harsh for many people. Losing critical care they need to stay healthy. This new policy won’t improve health outcomes but worsen them for many people and make it harder for them to work or stay employed.” [Twitter, 1/11]

Suzanne Wikle, Center for Law and Social Policy: “Access to Medicaid makes it easier for people to look for work and obtain employment. A so-called ‘work requirement’ does not support work, but instead puts a critical support for work at risk.” [National Public Radio, 1/11]

Jane Perkins, National Health Law Center Legal Director: “We know the upshot is people are going to be cut off… We are going to sweep in people who are working or trying to get work because they haven’t filled out the necessary paperwork. And cutting off people from Medicaid is certainly not going to improve their health.” [Los Angeles Times, 1/11]

Matt Salo, National Association of Medicaid Directors Executive Director: “This is going to go to court the minute the first approval comes out.” [Washington Post, 1/11]