People need Medicaid to work, not the other way around

On the eve of the Affordable Care Act (ACA) in 2013, Kentucky’s uninsurance rate was 16 percent—higher than the national average. The following year, Kentucky cut that rate in half by expanding Medicaid and developing an effective state health insurance Marketplace under the ACA. The state established itself as a national model for fully implementing the ACA to increase access to medical care and make it more affordable. Thousands of Kentuckians were able to go to the doctor for the first time in years.

Unfortunately, Kentucky Governor Matt Bevin is threatening to undo his state’s progress. One thing Bevin has done is request authority to make major changes to Kentucky’s Medicaid expansion, such as adding a work requirement to be eligible for benefits. The federal Centers for Medicare and Medicaid Services (CMS) have always rejected such requests, and they should continue to do so.

We know from other safety-net programs that work requirements don’t increase employment rates; rather, they result in loss of benefits and make program administration complex and bureaucratic.

Work requirements would be particularly harmful to Medicaid. If a person can’t work on account of poor health, withholding insurance will only worsen their condition—further reducing their prospects for employment. By contrast, making Medicaid more available promotes improved health status, making those with poor health more likely to become and stay employed.

A recent report from the conservative American Enterprise Institute (AEI) examined reasons why poor Americans are not in the work force and found that illness or disability are the top reasons why poor people are not working. This is particularly true for adults without children, the exact population Bevin’s proposal is targeting.

The authors of the AEI report argues that there must be a policy focus on improving the health of the poor in America in order to support employment. In the states that chose expansion, Medicaid does this already. Kentucky’s latest proposal would be a huge step back, preventing people with work-limiting illness or disability from receiving the care they need in order to enter the workforce.

If we’re truly serious about supporting work, we need to protect the gains made by states like Kentucky and move forward with Medicaid expansion in the remaining 19.