Why work requirements for Medicaid "don't work"
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Work requirements for Medicaid will reduce the number of eligible Americans covered under the health insurance program, according to experts and evidence from states that imposed them.
Why it matters: Work requirements are part of a budget bill from House Republicans that would impose big cuts to the health insurance program for the poor that covers 21% of Americans.
Where it stands: The bill would require Medicaid recipients who are under 65 years old, without dependents, to confirm they are working at least 80 hours a month. Another provision requires some to certify twice a year that they qualify for insurance.
- This provision, and other changes would increase the number of people without health insurance by more than 8 million, according to the Congressional Budget Office's tally, cited by Democrats, Sunday night.
Friction point: Typically the idea behind work requirements is to make sure people aren't free-riding off of cash benefits — choosing not to work, and living off food stamps or welfare checks.
- The thing is: You can't live off health insurance — it doesn't pay the bills or provide food.
By the numbers: There's little evidence that people are somehow free-riding on Medicaid.
- 64% of adults with Medicaid work full time or part time, according to an analysis of census data by the Center on Budget and Policy Priorities.
- Another 32% are taking care of home or family, are ill or disabled, attend school, or are retired.
- 2% could not find work. And there's another 2% in an "other" category.
Zoom in: Two states have imposed work requirements on Medicaid.
- In Georgia, they were tacked on to a Medicaid expansion effort; an estimated 240,000 were expected to enroll. Instead only about 5,500 gained coverage in the first year, per a report from the Georgia Budget and Policy Institute.
- Meanwhile the state spent $13,000 per enrollee just to sign them up.
- There were similar negative results in Arkansas, where a work requirement reportedly pushed 18,000 people off of benefits in less than a year's time.
The other side: The idea is to avoid subsidizing those who choose not to work, Rep. Brett Guthrie, (R-Ky.) said in a WSJ op-ed.
- "[O]ur bill would implement sensible work requirements," he writes. "Every other capable adult works to afford healthcare."
- The legislation would include carve-outs for those who can't work, but such exemptions are often onerous to qualify for, experts say.
Between the lines: Work requirements are the big Medicaid change that people so far find most politically palatable, with a majority of adults supporting them, writes Axios' Maya Goldman.
- While President Trump has said he won't cut Medicaid, he's also said to support work requirements.
For the record: "President Trump is protecting Medicaid for every eligible American who relies on it by eliminating waste, fraud, and abuse within this program," the White House said in a statement.
- "By taking commonsense measures to strengthen Medicaid, we will ultimately improve care for those who this program is intended to serve: pregnant women, the disabled, seniors, and low-income families.
- "The President has repeatedly said that he will save Medicaid to ensure it remains a reliable and sustainable lifeline for generations to come."
Reality check: Not all Republicans are on board for this. Some want more cuts, others want less.
- Sen. Josh Hawley (R-Mo.) published a full-throated defense of the program as critical for the working poor in the New York Times on Monday.
The bottom line: Safety net programs like Medicaid are supposed to catch vulnerable Americans and keep them from falling further into poverty.
- "Work requirements don't work," says Jennifer Wagner, director of Medicaid eligibility at the Center for Budget and Policy Priorities.
