Recent analyses bolster the case that attacks on Medicaid via work requirements—encouraged and permitted by the Trump administration—threaten the access to care and therefore health of millions of Americans.
Ten states have so far requested approval from the Centers for Medicare and Medicaid Services (CMS) to impose work or "community engagement" requirements on Medicaid beneficiaries. Three of them—Kentucky, Indiana, and Arkansas—have already received White House approval, while the other seven—Arizona, Kansas, Maine, Mississippi, New Hampshire, Utah, and Wisconsin—are waiting for the same.
Looking just at those 10 states, PwC's Health Research Institute found that the requirements will impact 1.7 million Medicaid recipients. That equals about half—46 percent—of the entire Medicaid populations in those states.
PwC notes that the requirements could lead to "a steady increase in uninsured patients." The analysis adds: "Many of the states requesting waivers also have rural hospital systems heavily dependent on Medicaid, struggling with low margins. Some states, such as Kentucky, have counties with rates of unemployment higher than the national average, which could make finding consistent work challenging."
Kentucky, however, was the first state to get the CMS seal of approval.
The Center on Budget and Policy Priorities (CBPP) put it simply: "Medicaid work requirements will almost certainly cause many low-income adults to lose health coverage."
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But as CBPP's analysis from last week highlights, it's not just Medicaid beneficiaries who aren't working that are at risk form the new requirements but those who are, in fact, working.
Less understood, many working people also will likely lose coverage due to work requirements. Most non-elderly adult Medicaid enrollees work, but in low-wage jobs that generally do not offer health insurance and are often unstable, with frequent job losses and work hours that can fluctuate sharply from month to month. As a result, our analysis finds that 46 percent of low-income workers who could be affected by Medicaid work requirements would be at risk of losing coverage for one or more months under a work requirement policy like Kentucky's. Even among people working 1,000 hours over the course of the year—about 80 hours per month, meeting Kentucky’s standard on average—1 in 4 (25 percent) would be at risk of losing coverage for one or more months because they would not meet the 80-hour requirement in every month.
"These estimates suggest that, if all states adopted work requirements along the lines of Kentucky's, millions of working people could lose coverage or face interruptions in coverage due to unstable employment or hours In addition, some enrollees who are actually meeting Medicaid work requirements will likely lose coverage because they get tripped up by the paperwork required to prove it," the analysis added.
Over 150 organizations recently expressed their opposition to the requirements and outlined their concerns in a letter to Health and Human Services Secretary Alex Azar.
Gabrielle de la Guéronnière, director of policy at the Legal Action Center, which helped draft the letter, said, "CMS's new policy cruelly punishes and stigmatizes low-income people—depriving them of the life-saving care that many need to become and remain healthy."