Medicaid Work Requirements Are a Disaster by Design


The Medicaid work requirements that states have implemented since the Trump administration allowed them to are premised on a lie. Advocates claim the requirements are intended to motivate people to work, but this is clearly not true. The real intention is to punish and oppress poor people for the crime of being poor, to further enshrine the kind of callous cruelty that is the hallmark of conservative ideology in government policy.

It is intended to tell poor people: You get nothing, and it’s your fault.

This is made clear by what’s happened in Arkansas. Until a judge blocked the requirements in March, thousands were losing insurance every month, as those who had previously lost insurance had to re-enroll. More than 18,000 Arkansans had lost their Medicaid coverage when the ruling was handed down. Many people who were subject to the requirements had no idea they existed, and the requirement to report hours worked was difficult to fulfill, in particular because it was done via a website that sucked enormously, and low-income people are less likely to have regular access to a computer.

The Arkansas experiment (technically, it is an experiment: the federal government issues waivers allowing states to “experiment” with things like work requirements) has been so bad that other states implementing work requirements are forced to pretend they don’t want the same thing to happen in their states. In December, for example, New Hampshire’s state health commissioner Jeffrey Meyers said states like Arkansas and Kentucky “may not have done a really good job to outreach to the population impacted before they turned the program on.”

Turns out New Hampshire also did not do a really good job.

On Monday, New Hampshire’s governor Chris Sununu signed a bill delaying implementation of the state’s work requirements for four months, because they were about to be an absolute disaster; almost 17,000 Medicaid recipients were not in compliance with the requirements, or 68 percent of those subject to the requirement, according to New Hampshire Public Radio. The New Hampshire law required 100 hours of work or volunteering each month—even more than Arkansas, which required 80 hours.

Last night, NHPR reported that this happened despite the state Department of Health and Human Services’ efforts to inform Medicaid recipients of the coming requirements, including “mailings to all Medicaid expansion beneficiaries, more than 50,000 phone calls, radio ads, public information sessions, and in recent weeks, door-to-door home visits.” The state’s health commissioner said that “only about 1% of those phone calls were successful.”

In June, the New Hampshire House passed a Senate bill that would scrap the work requirement entirely if more than 500 people lose health insurance because of it. At the time, the Union Leader reported that the bill faced “a likely veto from Gov. Chris Sununu, and did not pass in either chamber with veto-proof majorities.”

What, I wonder, is an acceptable number of people to lose insurance because of these requirements? How many people need to be punished for not working by losing their access to healthcare before it’s too many? I guess for Chris Sununu, it’s somewhere between 500 (far too low!) and 17,000 (oops, a bit high, how embarrassing).

The true answer, of course, is any people. Not one person should lose their access to healthcare because of their employment status. This is true, also, of people who lose their jobs and are suddenly uninsured. Employment status and income should not determine health coverage in any way, whether it’s because you earn too little to afford it or too much to be given subsidies.

Sixteen states don’t allow single, childless adults of any income level to enroll in Medicaid—a single adult could have absolutely no income in those states, and still be unable to access our supposed safety net health insurance program. In Texas, “for a single parent with two kids, the parent is only eligible for Medicaid if the kids are on Medicaid and total household income doesn’t exceed $230/month,” according to $230 a month. This, alone, if there were no other problems with our healthcare system, would be a desperate crisis. But it barely goes mentioned.

American healthcare is in crisis from every angle, at every level. It is shot through with cruelty, and chooses at every turn to value the ideology of markets over human life. Anyone who tells you that this system can be tweaked and built upon is consigning millions to misery and toil just to access the most basic needs of human existence. Anyone who doesn’t want to take this whole system and smash it to pieces—who isn’t filled with rage by every day that this oppression continues—doesn’t deserve your vote.

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