**UPDATE 7/11/17 – 4:45 PM** The House passed the bill through to the Senate 102-91. The Senate must again vote on the bill as amended
PA House Republican leaders are trying to force Pennsylvania to seek federal waivers for our Medicaid program that would establish requirements that Medicaid recipients either be working or searching for a job and that that ask them to pay premiums or higher co-pays for their insurance.
These ideas were part of Governor Corbett’s plan to expand Medicaid, which Governor Wolf rightly rejected.
Now, the House will vote on these terrible provisions as part of the budget code (instructions for implementing the budget) for 2017-18 after it was added as an amendment in the House Rules Committee.
What’s the objection to work requirements or premiums for Medicaid?
First, support for a work or job search requirement is based on a misconception that there are a large number of able-bodied adults who receive Medicaid, could work, and are not doing so. That’s simply not true. The vast majority of people who receive Medicaid are children, the disabled or seniors. Nearly eight in ten working-age adults on Medicaid are in families with one worker, and more than half are working themselves. Some adult Medicaid recipients do not work because they are ill, have a disability, care for children or other family members, are in school, or are looking for a job.
Moreover, Medicaid is not a way of life for able-bodied Americans. Studies that look at how long people stay on Medicaid show that in a three year period only about a third of people are on the program for the whole period, despite so many on the program suffering from illness or disability.
Second, creating premiums or additional co-pays for Medicaid undermines the whole point of the program, which is to help people whose incomes are so low that they cannot afford health insurance.
Medicaid recipients already pay co-pays for many services. About 40% of Medicaid Expansion enrollees report individual incomes of less than $503/month. At that level of income, additional co-pays or premiums would force people who live in poverty to choose between paying the health insurance bill and paying for food or rent.
Premiums for the program that benefits parents with disabled children is especially inappropriate. Parents with disabled children often face severe hardships. Some help with medical care, even to those with moderate incomes, is very well deserved.
Third, both work requirements and co-pays will deny people with legitimate claims benefits while wasting the money and other resources—and that, frankly, may be the point. Every time we add rules and regulations and other red tape to a human service programs, we make it harder for people to secure the benefits they deserve under the law. To add work requirements and co-pays fairly, in a way that does not have this effect, would cost far more in administrative support than will be saved. Of course, if the real point of the program is precisely to deny benefits to people who deserve them, then a slap-dash administrative procedure is fine—and is what is typically found in other states that set up these barriers to medical care.
Fourth, the politicians who push work requirements are the same ones who oppose policies that encourage work. One reason to expand Medicaid to those above the federal poverty line, and to create subsidized insurance in the exchanges for those above the cut-off for the Medicaid expansion, was precisely to do away with any disincentive to work created by Medicaid. We ought to let the new programs do what they are designed to do: encourage people to work by helping those who don’t get insurance at work and can’t afford to provide it for themselves.