Global Courant 2023-04-30 21:47:11
WASHINGTON — More than half a million of the poorest Americans could be left without health insurance as a result of legislation passed by House Republicans that would require people to work in exchange for health care coverage through Medicaid.
It’s one of dozens of provisions tucked into a GOP law that allow for an increase in the debt limit but limit government spending over the next decade. However, the bill is unlikely to become law. It is used by Republicans in the House to lure Democrats to the negotiating table and avoid a default.
Democrats have strongly opposed the determination of Medicaid’s job requirements, saying it will not incentivize people to get jobs and will increase the number of the uninsured in the country.
Here’s a look at how the proposal could save taxpayers money but cost some Americans access to health care.
WHO SHOULD WORK?
The job requirements say that able-bodied adults ages 19 to 55 who don’t have children or other dependents would be required to work, train for a job, or perform community service in order to remain on Medicaid. They would have to spend at least 80 hours a month to meet government-sponsored healthcare requirements.
About 84 million people are enrolled in Medicaid, and the Congressional Budget Office estimates that 15 million should meet the requirement. However, the Department of Health and Human Services predicts that millions more — about a third of enrollees overall — should work.
WHY ARE WORK REQUIREMENTS CONTROVERSIAL?
Republicans say the move would help push Americans toward jobs that could eventually allow them to get off state aid.
The requirements would also be fairer to those who work to support their families, said House Majority Leader Steve Scalise, R-La.
“That single mom who is currently working two or three jobs to make ends meet in this tough economy doesn’t want to pay for someone sitting at home,” Scalise said.
Democrats argue that job requirements can also unfairly push people out of Medicaid.
Chiquita Brooks-LaSure, administrator of the Centers for Medicare and Medicaid Services, told lawmakers that some people were unfairly kicked off Medicaid in Arkansas when the state briefly introduced work requirements. In some cases, people did not have to work, but did not fill out the required paperwork.
“It’s not just people who are subject to the requirements that often get caught up in bureaucracy,” she said. “Often it’s people who are exempt.”
About 1 in 4 people who had to work lost coverage during Arkansas’ experience of work requirements in 2018.
Work requirements can put Medicaid enrollees in trouble. While no one has been kicked off Medicaid in the past three years because of the pandemic, that changed in April when the federal government required states to review the income eligibility of all enrollees to see who now earns too much money to qualify for health care. .
People who have found work, earned a small raise, or changed jobs find that those new incomes could soon cost them coverage.
Amy Shaw, 39, of Rochester, New Hampshire, lost her family’s Medicaid coverage in April because of her husband’s 50-cent increase to $17 an hour at an auto parts store. Shaw wouldn’t be subject to the GOP’s job requirements because she has two daughters, but the family’s case illustrates how modest incomes can push people out of Medicaid coverage — and cost them a lot of money.
Suddenly, instead of a $3 copay, she was charged $120 for a cancer screening ordered by her doctor. Meanwhile, their rent has risen 40% since the start of the pandemic, and the cost of food, utilities and other necessities has risen.
“It seems like the system is set up in such a way that you don’t want to go back (to work) because you lose more than you gain,” Shaw said. “It makes me not feel like getting my mammogram and my colonoscopy. I don’t even want to go to those appointments because it’s going to cost so much money.”
HOW MUCH WOULD THE REPUBLICAN PROPOSAL SAVE?
That largely depends on how many people who should be working choose not to work or don’t fill out the proper paperwork to stay covered.
The Congressional Budget Office estimates that the requirements would save $109 billion over the next ten years. Those savings would come in two ways: from about 600,000 people who would be dropped from Medicaid, and then from 900,000 who would lose federal funding for their Medicaid but would remain enrolled in the program through their state.
That analysis also says the bill would do little to improve employment among Medicaid enrollees.
WHAT’S NEXT?
The House GOP bill will not pass a Democratic-controlled Senate or be signed into law by President Joe Biden in the current state.
But don’t expect the problem of job requirements and the reduction of Medicaid benefits to go away any time soon. The number of people enrolled in Medicaid has exploded in recent years, growing by more than 20 million since 2020.
If you ask the Democrats, that’s great – they’ve pointed to the record low uninsured rate that has allowed more people to access medical care. Democratic-led states have also proposed new ways to expand Medicaid under the Biden administration, such as extending access to recently released convicts and new mothers.
Republicans, however, want to scale back safety net programs to pre-pandemic levels. And Republicans in some states are already trying to implement their own job requirements. Arkansas Governor Sarah Huckabee Sanders asked the federal government to pass a proposal that would transfer anyone who does not meet Medicaid private insurance work requirements to traditional Medicaid for a fee.
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Associated Press writers Holly Ramer in Concord, New Hampshire, and Kevin Freking and Lisa Mascaro in Washington contributed.
