Minnesota avoids a policy mistake on health ‘reform’

The prestigious New England Journal of Medicine offers the latest evidence that Minnesota dodged a policy bullet in 2018 when Republican lawmakers tried but ultimately failed to enact work requirements for those on medical assistance.

Sudden sweeping health care changes, especially ones that could kick thousands of poor people off the benefits to which they are legally entitled, should be based on data, not wishful thinking. There is scant evidence that enacting work requirements, which requires enrollees and government staff to file reams more paperwork, actually does what its proponents intend.

Their goals are worthy: boosting employment and transitioning medical assistance recipients to private health insurance. But the question is whether simplistically adding red tape, which is all the new work requirements do, would accomplish these objectives.

The new Harvard study, published in the medical journal in June, analyzed results in Arkansas, the first state to implement work requirements. Their conclusion strongly suggests the answer is no. Instead, this so-called reform creates confusion and leads to fewer people having coverage. The results ought to serve as a flashing red light to any Minnesota lawmakers considering resurrecting this ill-advised policy.

Medicaid serves some of the nation’s poorest people -- including about 1 million Minnesotans. The income limit to qualify for medical assistance in the state is $16,611 a year (133% of the federal poverty level) for most adults. The state has another program, MinnesotaCare, for those earning a bit more.

The study should also serve as a warning to the Trump administration, which has made the policy “a central feature of its plans to restructure” the Medicaid program, according to a Kaiser Health News report. Medicaid is jointly run by the states and the federal government and serves more than 70 million poor, elderly and disabled Americans.

The administration is encouraging other states to implement similar burdensome paperwork requirements by approving plans to do so in eight states. Six other states have applied to do the same. In March, a federal judge blocked or halted two states from moving forward. But as Kaiser Health News reported, health experts predict vigorous legal challenges that will wind up before the U.S. Supreme Court.

The Harvard researchers had a real-world case to study, underscoring the credibility of their findings. Arkansas enacted the requirements in 2018 for adults ages 30 to 49, though it was one of the two states whose program was halted by the legal ruling earlier this year.

The program’s early results do not inspire confidence. An estimated 18,000 people were booted out of the program for failing to comply. Sadly, many were likely working already or eligible for an exemption from the requirements. But they still may have lost coverage due to widespread confusion about the changes.

Access to smartphones, computers and news sources isn’t a given for those who struggle financially. About a third of those who the requirements applied to in Arkansas hadn’t heard about the policy, researchers found. About half were unsure if they were now in the group that needed to comply.

Nor did the work requirements promote employment, which isn’t that surprising given the medical conditions, lack of transportation or affordable child care and other challenges that often accompany poverty. The percentage of people with a job actually dipped in the group of adults targeted for the requirements. Meanwhile, the percentage of people in this group without insurance ticked upward.

The Arkansas program didn’t have much time to roll out before the judge’s ruling. But the dismal early results sound a loud warning about this approach. Those who continue to advocate for this “reform” haven’t done their homework.

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