Work requirements will withdraw Medicaid’s ‘hand up’ assistance

By Elizabeth Lower-Basch

The Health and Human Services policy allowing states to create added barriers to Medicaid is the latest attack by the Trump administration on health care. Whether called “work requirements” or “community engagement,” these bureaucratic provisions will be costly and time-consuming. We know from experience with other benefit programs that eligible people already working or deemed exempt from working are likely to lose coverage simply because of added paperwork and enrollment hurdles — not because they are ineligible.

HHS announced Thursday its intention to allow states to deny Medicaid to otherwise eligible individuals unless they prove that they are working (or participating in related activities) for a minimum number of hours. The department is expected to begin to approve the state waivers immediately. This is contrary to the statutory goal of Medicaid to promote access to affordable health care. It is also contrary to HHS’s claim that “work requirements” promote work.

Without access to affordable health care through Medicaid, those who become ill or have chronic conditions find it harder to maintain employment. Although states claim they won’t apply work requirements to those with disabilities, evidence from other programs with similar requirements shows that people with physical and mental health conditions are disproportionately likely to lose coverage.  And over one-third of working-age Medicaid recipients not working are unemployed because of illness or disability.

HHS and the states proposing work requirements seem to assume that anyone who finds work will have access to employer-provided insurance and, thus, will no longer need Medicaid. For those in low-wage sectors such as food service, retail or child care, the chances are high that their jobs don’t offer health insurance. Prior to Medicaid expansion, many of these workers simply went uninsured, and too often missed out on needed care — and they still do in states that haven’t expanded the program. Medicaid offers a “hand up,” helping people stay in the workforce by getting needed care so they can provide for themselves and their families.

Many people insured through Medicaid are working low-income jobs with unpredictable and irregular hours. The reality is that many low-income jobs do not fit into the “9 to 5” box. The complications of juggling low-wage work schedules and other obligations in life (care for children or aging parents) make the extra documentation of changing work hours a burden for everyday Americans doing their best to make ends meet. And when someone gets sick, the last thing she needs to worry about is whether she’ll also lose her health coverage for not working.

Studies have shown that access to Medicaid makes it easier for people to look for work and maintain employment. Taking away people’s health care or ability to get needed medications only reduces their ability to work. A detailed evaluation of Medicaid expansion in Ohio by that state’s Department of Medicaid explains how it pays off for workers and taxpayers. Besides covering more people, Ohio’s expansion increased access to crucial health services, including treatment for mental health and substance abuse.

Because people got needed care, the report found that they were able to work more steadily. In fact, more than half of Medicaid expansion enrollees reported that health coverage has made it easier to maintain employment. Among those looking for work, nearly three-quarters reported that Medicaid helped.

And it’s not just Ohio. National evidence suggests that those who are unemployed and have significant health issues find the lack of coverage inhibits searching for or maintaining employment. Only once they are healthy will they be able to focus on employment. A report from the conservative American Enterprise Institute (AEI) in July 2016 found that illness or disability are the top reasons why poor people, particularly adults without children, are not working. Authors of the AEI report argue that policies must focus on improving the health of the poor to support employment. Medicaid expansion is exactly that type of policy.

If proponents of work requirements are serious about helping people find work, they would invest in skill training and workforce development programs, rather than increasing red tape and making it harder for people to access health care. None of the proposals from the states would make real investments in workers’ skills; rather, they would force additional paperwork burdens on workforce systems without the capacity to serve everyone who wants training.

HHS’s approval of work requirements for Medicaid is the next manifestation of the Trump administration’s attacks on health care and efforts to make it harder for people to get the supports they need to attain economic security.

Elizabeth Lower-Basch is the director of the income and work supports at the Center for Law and Social Policy (CLASP). Follow her on Twitter @ELB_CLASP.

Note: This op-ed originally appeared in The Hill on January 12, 2018.