Even conservatives wary of GOP’s work-for-Medicaid plan that could cut off new moms

By Tony Pugh

As Republicans move to impose work requirements on Medicaid enrollees, even some conservatives are leery about the proposal, knowing similar requirements for food stamps, cash assistance and other benefits have had mixed results.

Hoping to solidify waning support for the GOP bill to replace Obamacare, House Republicans amended it this week to allow states to require healthy adults, including parents, to work for their Medicaid health coverage. States could even block Medicaid benefits for new mothers who didn’t find work within 60 days of having a baby.

Single parents with children under age six and single parents of a child with disabilities would be excluded from the requirement.

The proposal was an olive branch to House conservatives, mainly Freedom Caucus members, who’ve criticized the legislation for being a new entitlement program that’s too much like Obamacare.

With a full House vote on the GOP bill still possible for Thursday, it’s unclear whether House Speaker Paul Ryan can muster the votes needed for passage.

Supporters say the Medicaid work requirement will foster an improved work ethic, cut government dependency and weed out people who don’t really need the assistance.

Critics say the requirement will be expensive to administer, provide an unnecessary barrier to coverage and penalize people who can’t work due to undiagnosed medical problems and care obligations for sick family members or school-age children.

According to the Kaiser Family Foundation, 35 percent of non-working Medicaid enrollees say illness or disability is the main reason for their unemployment. Twenty-eight percent reported care-taking obligations, while 18 percent couldn’t work because they were in school. Women made up sixty-two percent of Medicaid recipients without jobs in 2015, Kaiser reported.

“Given that most low-income adult Medicaid beneficiaries who are not working identify illness or care-taking responsibilities as the reasons they are not working, introducing work requirements for Medicaid may increase uninsured rates or require people to prioritize work over health and family,” according to a blog post on Tuesday by Anuj Gangopadhyaya, a research associate at the Urban Institute.

If it becomes law, most states probably won’t implement the work requirement because it’s optional, said Robert Rector, a senior research fellow at the conservative Heritage Foundation. That makes it “effectively meaningless,” Rector said.

If Republicans were serious about “reforming the welfare state,” Rector said, they’d add work requirements to the food stamp program, now called the Supplemental Nutrition Assistance Program, or SNAP.

When Maine required healthy adult food stamp recipients with no dependent children to work in 2014, most left the program, Rector said.

If similar requirements were mandated nationally, taxpayers could save $10 billion a year, Rector said in a recent commentary.

“It’s much more problematic to do that with medical care, because if they don’t show up at their (work assignment) and they get sick, what are you going to do?” Rector said. “The track record is very clear that nothing will happen.”

But the federal government requires half of people receiving Temporary Assistance for Needy Families, or TANF, to be in one of 12 work activities that include job search, training and readiness programs, community service programs, vocational training and education related to employment.

And “many, many people are sanctioned” for not meeting the requirement, said Elizabeth Lower-Basch, director of the income and work supports team at the liberal Center for Law and Social Policy.

The TANF program does, however, provide a number of protections for participants. For example, if a recipient needs child care and can’t get it, they don’t have to meet the work requirement.

“There’s no language like that in what they tacked on to the Medicaid bill,” Lower-Basch said. “One of the things that’s scary here is it was put in, in the middle of the night for political reasons and there hasn’t been a discussion about what it would look like.”

The Trump administration has already told states they’ll get more flexibility to revamp their Medicaid programs, suggesting that work requirements and premium contributions from Medicaid recipients will become more prevalent.

In a recent letter to the nation’s governors, Health and Human Services Secretary Tom Price and Medicaid administrator Seema Verma said the “expansion of Medicaid through the Affordable Care Act to non-disabled, working-age adults without dependent children was a clear departure from the core, historical mission of the program.”

The Obama administration rejected requests from Arizona, Indiana, Montana, New Hampshire and Pennsylvania for Medicaid work requirements.

But they allowed Indiana’s Medicaid expansion, which Verma designed, to require newly-eligible enrollees to pay premiums – sometimes as low as $1 or $2 per month – for coverage. Those who miss payments can receive lesser coverage or be barred from coverage for six months.

If the GOP health care bill passes the House, the Medicaid requirement will face immediate problems in the Senate where Democrats, led by Sen. Chuck Schumer, D-N.Y., will try to kill it along with new restrictions in the bill on health coverage for abortions.

Democrats will argue that both provisions violate the Senate’s parliamentary Byrd Rule, which prohibits substantive policy changes that don’t meaningfully impact the budget from being implemented through the reconciliation process.

If the Senate Parliamentarian agrees and determines that the work requirement is “extraneous” to the bill’s goal of making changes to the budget, 60 votes would be required to overturn the ruling.

That would effectively kill the work proposal because Senate Democrats unanimously oppose the GOP bill.

“The fact that Republicans are pushing for a bill that would not only take coverage away from tens of millions of people and spike premiums, but could kick struggling new mothers off of Medicaid right when they need it, is absolutely mind-boggling –and heartless,” said an e-mail statement from Sen. Patti Murray, D-Wash., ranking member of the Senate Health, Education, Labor & Pensions Committee.

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