Opinion Columns & Blogs

Work requirements run counter to Medicaid expansion’s intent — no matter your politics

Lauren Necochea, of Idaho Voices for Children, speaks against a waiver to add work-reporting requirements to Idaho Medicaid. She was joined by two physicians who said their professional experience and outcomes in other states make them opposed to restricting Medicaid coverage.
Lauren Necochea, of Idaho Voices for Children, speaks against a waiver to add work-reporting requirements to Idaho Medicaid. She was joined by two physicians who said their professional experience and outcomes in other states make them opposed to restricting Medicaid coverage. adutton@idahostatesman.com

The purpose of Medicaid expansion, as approved by voters with 61 percent of the vote, is to simply get more people on health insurance.

It’s not just a bleeding-heart liberal goal. Getting more people on health insurance, certainly, is good for those Idahoans, but it’s also good for business (healthy workers show up for work), and it’s good for the taxpayers (preventative care is cheaper than emergency care).

Just on its face, the proposed work-reporting requirements being pushed by some legislators is a bad idea. By the state’s own concession, as many as 16,000 Idahoans who are intended to benefit from Medicaid expansion would end up without health insurance because of the requirements of reporting. Other estimates put it at closer to 21,000 Idahoans.

I get it, though: We all want the world to be the way the world should be. Everyone should be gainfully employed with a full-time, 40-hour-a-week job. Everyone should pull themselves up by their bootstraps, work hard and work your way up to manager. Everyone should be able to afford their own health insurance. Everyone should take care of themselves, have healthy diets, exercise, etc.

Unfortunately, the world isn’t always the way it should be.

For many of us who have decent jobs sitting in climate-controlled cloth-covered cubicles in front of computers all day during regular working hours, Monday through Friday, it can be difficult to empathize with our neighbors who have a different work experience. They work jobs where they are at the mercy of their bosses who can control their work hours, giving them 32 hours one week only to change their hours to one shift the next week. Working a second job to make up the difference is challenging if not downright impossible because they might work afternoons one week, nights the next, early mornings the following week, and meshing a schedule with another job just doesn’t work.

But let’s make the case on a more conservative basis: Instituting work requirements as part of Medicaid expansion is an expansion of government bureaucracy, introducing a whole new set of paperwork and administrative expenses. All for what? To make sure that someone doesn’t game the system? Idaho Gov. Brad Little just got done touting the state’s efforts to get rid of pages and pages of administrative rules (ostensibly making it easier for businesses to do business), only to have the Legislature turn around and add a bunch more bureaucracy (to make it harder for poor people to get health insurance).

So back to the bottom line: The goal of Medicaid expansion is to get more people on health insurance, for their benefit, for the benefit of business and for the benefit of taxpayers. The more people we get on Medicaid, the more beneficial it will be for all of the above. Reducing those numbers (which, let’s be honest, is an effort to get those who are considered to be undeserving because they are able-bodied workers who should be able to take care of themselves without government assistance) reduces the benefit that voters sought when they overwhelmingly approved Medicaid expansion in the first place.

Before a Close the Gap Idaho press conference this week, I spoke with Dr. Lesleigh Box, a Boise physician who works for St. Luke’s and Saint Al’s and is the health policy chairwoman for the Idaho chapter of the American College of Physicians, about the work requirements.

“Most people don’t just want to sit around and do nothing,” she said. “People want to work. But kicking someone off Medicaid because they didn’t fill out the paperwork properly won’t make them healthy. But making a sick person healthy will get them to work.”

Scott McIntosh is the Opinion editor of the Idaho Statesman. You can email him at smcintosh@idahostatesman.com or call him at 208-377-6202. Follow him on Twitter @ScottMcIntosh12.

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Always full of opinions and tolerant of others, Scott McIntosh is the opinions editor for the Idaho Statesman. He has won dozens of state and national awards, including Best Editorial from the Idaho Press Club for 2017.
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