Medicaid expansion under threat: The impact of proposed work requirements on Idaho | Opinion
There’s good and bad news out of the Senate Health and Welfare Committee this week.
The good news: Chairman Julie Van Orden, R-Pingree, is holding in her desk a bill that would almost certainly result in the repeal of Medicaid expansion, as the Idaho Capital Sun reported.
The bad news: Van Orden is a co-sponsor of a new bill that would impose a variety of cost-cutting changes to Medicaid expansion.
Don’t lose the big picture. Van Orden should be commended for forcing negotiations that resulted in a better proposal — tens of thousands of Idahoans will benefit from it. This bill is much better than the one sitting in her desk drawer. It also gives important direction to the Department of Health and Welfare about what to do if an increasingly chaotic federal government reduces the 90% share of the Medicaid expansion bill it picks up — namely by chopping optional benefits and reducing provider compensation rates to offset the funding cuts.
But the bill is far from perfect. And the worst part of the bill — the one that could result in tens of thousands of people losing health insurance — is the one that seems to be most appealing: work requirements.
After all, Medicaid expansion is meant to provide coverage to the working poor — people with too much income to qualify for traditional Medicaid, but not enough to qualify for Affordable Care Act subsidies.
The work requirements outlined in the bill aren’t onerous. They require able-bodied recipients to either work, participate in an employment program or volunteer 20 hours a week. There are exceptions for pregnancy, caring for young children or attending rehab programs.
It’s hard to object to any of that, and I do not doubt that the proposed work requirements come from the good intention to insure that benefits go only to those who were intended to benefit.
But good intentions aren’t sufficient to ensure good policy outcomes. The best way to determine what a policy will actually do is to look at past instances where similar policies have been enacted.
Only one state, Arkansas, actually implemented Medicaid expansion work requirements before being blocked by the courts, and the effects have been fairly well studied.
The conclusion: Work requirements did work to cut the costs to taxpayers. But they didn’t do it by kicking deadbeats out of the system; they did it by kicking out working people.
An analysis by the Center for Budget and Policy Priorities found that during the seven months that work requirements were in place, more than a quarter of people subject to work reporting lost coverage. Researchers at Harvard point out this is despite the fact that 95% in fact met the work requirements. Both of these findings are similar to ones by the Kaiser Family Foundation.
“In other words, red tape is the primary hurdle to maintaining coverage,” the Harvard researchers reported.
This is the key thing to understand: The effect of a work requirement is not to require Medicaid recipients to work. The effect is to require Medicaid recipients to prove to the government, over and over again, that they meet the requirements.
The effect is death by red tape — odd for a state like Idaho, which claims to love cutting red tape.
A series of focus groups convened by the Urban Institute found that many people had no idea work reporting requirements were in place. Among those who did, many were not internet savvy and had tremendous difficulty navigating online portals. Many others lacked access to the internet. This is a pattern seen not just with Medicaid work requirements, but with work requirements for other programs like SNAP, the Economic Policy Institute found.
What happened to this group of people, almost all of whom were working?
One study, previously hosted by the U.S. Department of Labor but now apparently purged from the site, tracked what happened to this group.
Death by red tape can sometimes be literal. Among those who lost Medicaid coverage, 56% reported delaying necessary medical procedures because of the cost and 64% reported not taking their medication as prescribed, according to the study.
That is exactly how people die because of their lack of access to health insurance. For instance, they might rely on a rescue inhaler to treat their asthma instead of more comprehensive treatment and die of a preventable asthma attack.
This is exactly what happened to Jenny Steinke, whose case became the rallying cry for Medicaid expansion. She delayed more comprehensive treatment, waiting for her health insurance to kick in to make treatment affordable. But she died before that could happen.
Kick working people off of Medicaid expansion with a flood of red tape, and the result will be quite predictable.
Lawmakers should drop the work requirement to ensure it doesn’t happen.