Two problems with a Medicaid work requirement

Don't expect Medicaid work requirements to make a big difference

By Drew Altman, president and CEO of Kaiser Family Foundation
Axios, April 3, 2017

Medicaid "work requirements." But their impact depends on how they are implemented and is likely to be very small — because most people on Medicaid who can work already are.

With Trumpcare dead for now, expect Republican governors to begin submitting waiver proposals to the Department of Health and Human Services to move their Medicaid programs in a more conservative direction. Medicaid "work requirements" are likely to be an element of many of those waiver requests, possibly from Republican-led states now looking to expand Medicaid under the Affordable Care Act.

During the Obama administration, HHS rejected mandatory work requirements as inconsistent with the purposes of the Medicaid statute, spurning requests from Arizona, Indiana, and Pennsylvania under a previous governor. Under the Trump presidency, HHS is expected to approve them.

Liberals find Medicaid work requirements repugnant because they believe that Medicaid beneficiaries want to work if they can, and that providing health coverage to people who cannot afford it is an obligation of any moral nation. Conservatives who favor work requirements see Medicaid coverage as another form of government welfare benefit, like cash assistance, requiring reciprocal obligations from beneficiaries, and a disincentive to work.

The reality, though, is that most Medicaid beneficiaries are working already, and the vast majority of those who are not working are likely to be exempted from all but the most draconian Medicaid work requirements when front-line caseworkers apply state rules.

* 59% of all Medicaid beneficiaries who were not on Supplemental Security Income — the program for low-income people with disabilities — were working full time (41%) or part time (18%) in 2015.

* That leaves 41% who were not working. Of those, the vast majority (89%) had reasons for not working, including that they were sick or had a disability (35%), were taking care of a family member (28%), or were in school (18%).

* Another 8% said they could not find a job which, when documented, usually satisfies work requirements.

* All told, just a tiny subset of Medicaid beneficiaries are-able bodied adults who do not have a reason for not working that would fail to pass muster with a state case worker.



By Don McCanne, M.D.

Why are some people opposed to other people having health care? In the case of Medicaid, some conservatives would deny people health care merely because they failed to meet certain work requirements. It is not as if this is a ubiquitous problem since, according to this report, only a tiny subset of Medicaid beneficiaries are able-bodied adults who do not have a reason for not working.

Is the denial of medical care a proper punishment for not being able to find a job? Only 3 percent of Medicaid beneficiaries fell into this category - lower than the national unemployment rate. And the conservatives would deny them care? This seems to be an unusually cruel punishment for what is largely a circumstance of fate.

The other issue is who really deserves to be denied health care? Nobody you say? Then why don’t we have a system that guarantees that everyone does have affordable health care when needed, like maybe an improved Medicare for all? Segregating people into arbitrary groups for health care coverage leaves many out, such as what would happen under these conservative work requirements for Medicaid.

HHS Secretary Tom Price and CMS administrator Seema Verma like these work requirements and are eager to grant states the right to exercise them. And we tolerate this in our government? What have we become?