EDITORIAL: Hardly working: Medicaid work requirements are a bad approach to providing health care

Aug. 6--U.S. District Judge James Boasberg's ruling last week that New Hampshire's work requirement for Medicaid recipients is "arbitrary and capricious" and cannot be implemented as written is further indication the entire idea was a bad one from the start.

Boasberg, who has ruled similarly on work requirements in Arkansas and Kentucky, noted the provisions don't do anything to help gain health coverage for those in need -- ostensibly the point of the expansion in the first place. Instead, they keep more people from obtaining care, which in turn keeps them from being able to get or hold jobs. He found New Hampshire's requirements were even "more exacting" than in the other two states.

Among the clear inequities, too, is that the work requirement only applies to those who gained Medicaid coverage through the expansion under Obamacare; anyone who already qualified for the program doesn't have to bother with it.

Conservatives have long argued, under the flawed assumption that millions of Americans are hoping to simply take advantage of "handouts" because they're lazy and don't want to work for what they get, that Medicaid -- which provides health care and other relief to the poor -- should come with a requirement that those receiving aid prove they're trying to do their share.

When Obamacare provided the option to expand the reach of Medicaid in New Hampshire, Republicans recognized it as a beneficial move, but tried unsuccessfully to tie it to a work requirement. Last year, when that original expansion -- which has improved access to health care for about 50,000 Granite Staters -- was set to expire, GOP legislative leaders took advantage of their majority and a friendly face in the governor's office to push the stipulation through as part of a five-year extension.

As expected, New Hampshire Democrats cheered last week's ruling, while Republicans damned it as an activist judge interfering with a beloved and needed change in the program.

Said Gov. Chris Sununu of the ruling: "New Hampshire's work requirement is a key provision of the bi-partisan Medicaid expansion bill that passed with overwhelming support in the legislature."

This is the sort of political statement that combines fact and fiction to create a false impression, something Sununu excels at. In this case, it's true the expanded Medicaid extension passed overwhelmingly a year ago, and that the work requirement was a "key provision" -- for Republicans.

Democrats universally hated it, but had no power to stop it, so they acceded to the provision in order to get the overall bill passed. Extending the state's Medicaid program, without which assistance to tens of thousands of Granite Staters would have ended, was a priority for lawmakers of both parties. That they voted for the bill was neither support of the work requirement nor a promise on the part of Democratic lawmakers to continue to back it, which was evident this past session, when they immediately introduced legislation to lessen the impact of the provision.

Sununu signed that bill July 8 -- two days before nearly 17,000 Medicaid beneficiaries would have been kicked out of the program for not providing evidence that they'd adhered to the requirement. For many, that failure was due to issues the state had in setting up its online system by which the recipients could verify their compliance. Or because they didn't even know about the requirement -- a dynamic that mirrors the shoddy implementation in other states. Once Sununu signed the bill, the state immediately implemented a four-month waiver to keep those people in the program and give the state time to fix its own problems.

Even if it gets there, it's still a bad approach. These "community engagement" provisions are nothing more than excuses to limit the reach of Medicaid and thus, the amount spent on it.

A recent study in the New England Journal of Medicine looked at the results of the first year of Arkansas's work requirement. It found employment didn't go up, but health coverage through Medicaid went down by about 12 percent. Another study, published in 2018 by the Center on Budget and Policy Priorities, found a similar provision in the Temporary Assistance for Needy Families program in Kansas pushed about 9 percent of recipients to find jobs that "lifted themselves up," while 36 percent of recipients were denied coverage for not meeting the requirement. That's not helping people; it's punishing them.

Ultimately, Medicaid is not a jobs program; it's a health care program. It's meant to provide access to care for those who can't work or don't find work that pays enough to afford a health care plan. Adding hoops -- especially those that include burdensome reporting requirements, hinders that goal.

Instead of trying so hard to weed out recipients of public assistance and figure out who "really needs it," how about we try to figure out why so many do, and act on that information?

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