As working people in several red states celebrate the official expansion of Medicaid due to victorious ballot initiatives, others living under the boot of cruel Republican governors are beginning to lose their health care en masse.
Last summer, Arkansas became the first state to implement work requirements as a condition of receiving Medicaid, a new and pernicious hurdle made possible by waivers offered by the Trump administration. The new law requires some Medicaid recipients ages 30-49 to spend at least 80 hours a month working, volunteering, or looking for a job. So far, 17,000 vulnerable people have been kicked off their bare-bones state healthcare because they did not meet the threshold.
That number is bad enough, but the context makes it even more disgusting. Most people on Medicaid in Arkansas were not required to report their hours because they were already either employed, have a small child at home, disabled, or otherwise unable to work. The Kaiser Family Foundation broke down the numbers for November, and they don’t paint a pretty picture:
“The large majority (83%, or 53,975 people) were exempt from the reporting requirement for November 2018,” the center reports, “while 78% of those not exempt (8,426 out of 10,768) did not report 80 hours of qualifying work activities.”
It’s clear that people on Medicaid want to work, as nearly 98% of those exempt were indeed employed for more than 80 hours a month. So what happened to the non-exempt people?
First and foremost, the rules are cruel and difficult for people to follow; poverty brings a huge set of challenges, and job hunting often takes a back seat to trying to find food and medical care or and fulfilling other responsibilities. And in many situations, those that did work had a lot of trouble submitting their hours, as Arkansas’s system comes with complicated reporting procedures and arcane technology that has made it incredibly frustrating and sometimes impossible to use.
There have been a litany of issues. In the largely rural state, broadband connectivity is spotty; not everyone subjected to the requirements even got the notice; and the state has not put in any effort to help people work within the new system. There was no special help at county offices with online kiosks, and it took months and a lot of outrage for the state to introduce a phone line for reporting. It is a byzantine system designed to fail.
Racheal Holmes said she lost her benefits at the end of October despite going to a Department of Human Services office in Little Rock once a month to log her hours.
Holmes, who had been working at a grocery store, said it took hours just to log in to the online reporting system the first time. A state worker offered help only after a security guard noticed she was still at the office after several hours, she said.
“You couldn’t get basic assistance, as though it’s a way for you to fail,” said Holmes, who is currently unemployed and has been unable to afford medication to treat high blood pressure since her coverage lapsed. She doesn’t think the work requirements are unfair but asks, “Where’s the assistance?”
Unfortunately, there are several more states — all GOP-controlled — that are planning on implementing similarly barbaric work requirements.
Kentucky, led by reviled Gov. Matt Bevin, had its work requirements plan briefly thwarted by a US district court judge, but in November, the state was given the green light to abandon its poor. That system is set to go into effect in April — just seven months before Bevin is up for re-election.
Also in November, Trump’s HHS approved New Hampshire’s request to install work requirements, which will ask eligible recipients to work at least 100 hours a month, and apply to people 18-64 and parents with children older than 6. Democrats, who now control the legislature there, say they do not plan to fight to roll the requirements back — they helped negotiate them.
Indiana also was approved to introduce work requirements early last year. The state has pressed long punishing conditions on its Medicaid recipients, which were enacted in a deal with the Obama administration as part of its expansion.
Via the Washington Post:
Under those requirements, people in the program already must pay monthly insurance premiums into Personal Wellness and Responsibility (POWER) accounts intended as incentives for them to stay healthy and use cost-effective care — or risk losing eligibility or certain benefits. People who fail to keep up their premium payments are being locked out of the program if their incomes are above the poverty line — or bumped down to a level of coverage with fewer medical benefits if they are in poverty.
Indiana will make the new requirements mandatory for all parents of children over 6-years-old. People over 60 will be exempt, as will the chronically homeless or recently incarcerated. In total, about 130,000 people on Medicaid in Indiana do not currently match the projected requirements, making for a potential social safety net blood bath.
Oh, and South Dakota is considering implementing work requirements, as well.
This is a reminder of how awful Republicans are, of how wantonly cruel and mendacious they always act. And it’s also a good reminder that we can’t stop fighting until we achieve federally administered Medicare for All, because this patchwork, for-profit system is literally leaving millions for dead.