At both the state and federal level, Republican Party leaders seem to be on the warpath against Medicaid. Thankfully, rank and file Republicans in both legislatures and the public seem to be pushing back against them, as long, bi-partisan support for Medicaid continues.
At the federal level, both the Senate and House Republican health care bills call for drastic cuts to not just the Medicaid Expansion but traditional Medicaid. The cuts they propose will lead to tens of thousands of seniors, children, disabled people and working adults losing health care. Thankfully some Republicans are pushing back against the proposal. Four Pennsylvania Republican members of the U.S. House delegation voted against the House bill. And while Senator Toomey is pushing to make the Senate bill worse, so far he hasn’t convinced all his Republicans colleagues to join him.
In Pennsylvania, Republican leaders want to seek federal waivers for our Medicaid program that would allow the state to establish requirements that require Medicaid recipients either be working or searching for a job or 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.
From some perspective, these ideas might seem like good ones. Both left and right believe that everyone should pay their fair share for health care. So 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. Of the working-age adults on Medicaid, according to a Kaiser Family Foundation study, nearly eight in ten are in families with one worker, and more than half are working themselves. Some adult Medicaid recipients do not work. That’s almost always because they are ill, have a disability, care for children or other family members, are in school, or are looking for a job.
Much the same is true in Pennsylvania. A study by the Department of Human Services found that nearly half of those covered by the Medicaid expansion were working throughout the first year, while many of those who were not were diagnosed with a serious chronic illnesses like heart disease and diabetes that made it impossible for them to work.
Moreover, contrary to the impression that conservatives like to create, 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. A third are on the program for only 12 months or less in a three year period. For most able-bodied adults, Medicaid is a temporary solution that helps them and their families stay healthy when, due to economic conditions or bad luck or illness, they need a hand up. And that means, of course, that the number of people who benefit from Medicaid is far greater than those who are on it at any one time. While the definitive study is yet to be done, if we include all those who are born while their mothers are receiving Medicaid, it’s likely that close to 60% of Americans will be on Medicaid for at least a short period in their lives.
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. But those co-pays are set at a level appropriate for their inomes. About 40% of Medicaid Expansion enrollees report incomes between 0 and 50% of the Federal Poverty Line. This means that an individual lives on less than $503/month or a family of four lives on less than $1025/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. And that’s why study after study shows that premiums for Medicaid would leave many without coverage or health care that leads people to suffer and die from untreated illness.
Third, both work requirements and co-pays will deny people with legitimate claims benefits while wasting the money and other resources. 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. And enforcing those rules and regulations on the 1.6 million adults enrolled in Medicaid is time consuming and costly. At a time when resources for health care are stretched thin, it makes no sense to divert funds from doctors, nurses, and hosptials.
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. The ACA makes it possible for people enrolled in Medicaid to seek jobs and better paying jobs without fearing that they would lose health insurance for themselves and their families as their wages increased. Instead of cutting back benefits while imposing new work or job search requirements or premiums, 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.
There are signs that many Republicans in and outside of government are coming to recognize that now is the time to join together to make Medicaid and the entire ACA work better, not a time to create an unnecessary health care crisis on the basis of ideological extremism. Let’s make sure that legislators in Pennsylvania get the message as well.