President Trump wrongly stigmatizes the poor with plans for Medicaid work requirement

Andrew Cummings
January 19, 2018

Last week, the Trump administration signaled that it would allow states to impose work requirements on able-bodied recipients of Medicaid, the program that provides health care to the poor, disabled, and children of low-income parents; the administration granted the first waiver to the work-requirement prohibition to Kentucky on Friday.

"With this guidance from CMS, it will be essential for states and stakeholders in the states - including insurance providers - to understand the details of who will be impacted by work requirements, how these requirements will be defined and administered, and how people who are impacted will be directed to new pathways for coverage and care", said Kristine Grow, a spokeswoman for America's Health Insurance Plans, a national trade group.

The justification for this unnecessary requirement is based on a blatant lie. According to 2015 data from the American Community Survey, almost 70 percent of Medicaid recipients would be exempt from these requirements, because they are children, elderly or disabled.

Q: Would all those people be forced to work if North Carolina's request were granted by the Centers for Medicare and Medicaid Services? Those days are long gone.Today, politicians - including in the Trump administration, which last week said it would allow states to tie Medicaid benefits to employment - use the term "work requirement" to hide the true nature of their proposals. The bill would expand Medicaid to several hundred thousand residents - but with conditions, including that they pay monthly premiums for their government health insurance, and that they work. States that have expanded access to the program are finding it has significantly improved the health and financial stability of its citizens.


Medicaid expansion also has played a key role in combatting the opioid epidemic.

Ending the program could leave up to 480,000 Kentuckians without healthcare coverage.

The proposed work requirement mandates only 20 hours of work per week for new enrollees; then 25 hours after receiving 12 months of benefits; and 30 hours after receiving 24 months of benefits. Between 2013 and 2015, Kentucky's uninsured population plummeted from 40 percent to 9 percent; low-income citizens reported more primary and preventative-care and fewer emergency room visits. The state government, led by Republican Gov. Matt Bevin, is expected to reap $300 million over the next five years in "saved" Medicaid costs.

A Health Affairs analysis found that 11 million Medicaid enrollees would be at risk of losing coverage if the work requirement spreads nationwide.


The president's political ploy to undermine Medicaid might play to his base of supporters, but there's reason to believe it could backfire at the ballot box.

While there are advantages to encouraging work and volunteering, many people hearing about these potential new requirements are nervous about what the changes will mean. "My only hope is that the chaos caused by this policy and the desperation of the Kentucky families who will soon lose their only access to health coverage will force Governor Bevin to demonstrate some level of compassion and reverse this disgraceful policy". They put Question 2 on the ballot and decided that people shouldn't have to choose between feeding themselves and healing themselves. Bevin says the program is too expensive to continue without his changes. And that victory was just a start.

Kentucky is the first state to be approved to undergo the drastic change.


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