The Trump administration is pushing to impose work requirements on Americans who rely on the Medicaid program for their health care. Sixteen states have taken up the President’s team on its explicit invitation to place this extra demand on their states’ residents who count on Medicaid for access to their medicines and treatment. There are high-level discussion about applying Medicaid work mandates across the country.
Republicans realize that work requirements can undercut the Affordable Care Act’s most effective component: the expansion of Medicaid. They are counting on these regulations inflicting their damage outside of congressional and popular scrutiny. In the process, they are promoting false information on what Medicaid work requirements will do.
Lie #1: Work requirements will encourage work
If President Trump and the states following his lead were actually concerned about able-bodied persons on Medicaid engaging in work activity, they could rest easy. Studies by the Kaiser Family Foundation and the Center on Budget and Policy Priorities show that the vast majority of Medicaid enrollees who can work already do so. Those who aren’t working are usually disabled or are caregivers, and thus exempt from work requirements.
The cruel irony of the Trump plan is that it is likely to worsen this status quo, not improve it. Decades of research show that access to health care increases the likelihood of a person consistently working. Pulling it away hurts their chances. As the documented outcomes of the Affordable Care Act prove, people who obtain health care are better able to seek and maintain employment. They are less likely to have unmet medical needs that mushroom into crises that require expensive hospital treatment — and loss of their job.
Lie #2: Work requirements won’t kick people off Medicaid
Arkansas is the first state to implement Medicaid work requirements. In just four months of the program, over 18,000 people have lost their health care for failure to comply with the requirements. Likely, many of those kicked off the program are working and/or are disabled or caregivers, and thus should not be removed. But surveys have shown that many Arkansas enrollees are simply not aware of what is required of them in the red-tape process. None of this is a surprise, as work requirements on other public benefits programs have been shown time and again to harm persons with disabilities or caregiving duties.
Imposing work requirements on public benefits is a policy with deep roots in racist demagoguery. Yet, the racist intentions behind work requirements are not only hateful, they are inaccurate. Most people on Medicaid, as in all government programs, are white. Recently, I attended a discussion about Indiana’s proposed Medicaid work requirements, created by a white governor and embraced by a white-dominated legislature. An African-American minister in attendance spoke up. “They like this idea now because they think it is going to hurt us,” he said. “They won’t be so excited when it turns out to be hurting them.”
Lie #3: Work requirements won’t cause suffering
I am an attorney and law professor representing low-income clients in Indiana. I know young mothers like Amber Thayer who have been kicked off Medicaid and have struggled to get their medications due to our state’s unclear and inconsistently-applied regulations. Thousands have lost their health care. In a Medicaid work requirement system that creates yet another layer of red-tape regulations, many more people will fall through the cracks. They will not be able to find and keep sufficient employment, or they will stumble when jumping through the bureaucratic hoops set up to qualify for exemptions.
For example, many persons on Medicaid who are not working are living with significant disabilities. But research by the Kaiser Family Foundation estimates that more than half of those disabled persons have not yet received official confirmation from the Social Security Administration of their disabled status. That means they may struggle to prove they should be work-exempt. Millions of others who are caregivers for elderly or disabled family members should also qualify for work requirement exemptions. But it is unclear how such exemptions will be defined and applied.
One truth: It’s not too late to stop this
The good news is that Arkansas is the only state so far to implement these new work requirements, and the disastrous results there have helped spur rising opposition. In November, the Medicaid and CHIP Payment and Access Commission urged the Trump administration to stop using work requirements to take away health care. Lawsuits have challenged the work requirements in several states, and a federal judge temporarily halted its rollout in Kentucky.
The faith community has contributed to this resistance, both in grassroots efforts and at the national level. But people are still being hurt in Arkansas, and millions of others are at imminent risk. When President Trump tried to gut the Affordable Care Act on Capitol Hill, the faith community and health care advocates found our voices and fought back. We must find that same resolve in all of the states where these lies are being peddled where the potential increase of suffering is lurking right around the corner.
Fran Quigley directs the Health and Human Rights Clinic at Indiana University McKinney School of Law and is active in the Religion and Socialism working group of the Democratic Socialists of America.
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