OPINION: Listen to Jesus, not GOP, on Medicaid work requirements

April 01--Many of us are celebrating Easter this morning, marking the resurrection of the Son of God, who charged us in no uncertain terms to serve the poor.

It's a message seemingly lost on our Republican state lawmakers, many of whom will surely go be at church this Easter morning, but plan, when they return from spring break, to get cracking on a bill that would require recipients of Medicaid to prove that they work at least 30 hours a week in order to retain the benefits that may keep them employable, healthy or alive.

Cheap shot? Yeah.

But it's also an ugly truth.

S.B. 897's sponsors cloak their work in the language of personal responsibility: Able-bodied adults should work. Government should provide a hand up, not a hand out.

The Michigan Chamber of Commerce's Richard Studley, who does not particularly care about cloaking things, told the Gongwer news service that too many people have obtained insurance since the state's Medicaid expansion was passed, and that employers don't like that. (Employers, you might want to give Studley a call, because I have more faith in your compassion than he does.) Guidance from the administration of President Donald Trump gives states the option to impose such a requirement, for the first time in the program's history.

The bill's sponsor, Sen. Mike Shirkey, R-Clark Lake, says this isn't about money. A state Senate Fiscal Agency analysis estimates it would cost $20 million to $30 million to implement and administer, and that any savings would likely be "slight."

This is a nasty little piece of legislation, indulging in the most destructive stereotypes about poverty, the notion that folks who receive benefits are lazy jerks who'd rather exploit the system than find a job.

Nearly 50% of enrollees in the Healthy Michigan expansion do work, a 2017 study conducted by University of Michigan researchers found. Of the rest, 5% were students, 4.5% were homemakers, 11% said they were unable to work and 2.5% were retired. Just 27.6% were considered to be out of work, and three-quarters of those say they're living with a chronic physical condition like diabetes, asthma or cancer, or a mental health condition -- in other words, taking away health-care coverage means they're less likely to find work.

"Medicaid recipients who are working would have to proceed through another bureaucratic hoop to maintain coverage, while they have health care needs they're currently seeing us for," said Paul Propson, CEO of Covenant Community Care in Detroit, a primary health care provider that sees 20,000 patients with Medicaid benefits or no insurance coverage each year.

Because people who live in poverty tend to move more frequently, it can be difficult for mail to catch up with them, Propson said: "They can lose coverage because they don't know that they need to document this requirement."

Michigan extended Medicaid eligibility to residents with household incomes at 133% of the federal poverty program in 2013 as part of the Affordable Care Act. For a single person, that's $21,600 a year. For a family of four, it's $32,178, or about $618 a week before taxes.

This is not very much money.

About 687,000 people have received insurance through this Healthy Michigan program; about 2 million Michiganders total receive Medicaid health benefits.

If this legislation passes, the number of people who get those benefits will decline. Some recipients may find work -- this legislation directs the state Department of Health and Human Services to direct Medicaid recipients to transportation or childcare resources -- but some will drop off the Medicaid rolls because they simply cannot find work.

Those folks? They'd just be out of luck.

"By and large, there's no help for people who don't have insurance in this country," Propson said. "The big question we need to be asking is, what person with diabetes should not get insulin? What person with an abscessed tooth should not get an extraction? Since most people would answer that it is unthinkable that they themselves should ever be denied treatment of an infection, why would we withhold it from people who we're requiring to do additional work to show they have a job?"

The legislation includes some exemptions: anyone who is the sole caretaker of a child under 6 months (non-single parents need not apply?), a disabled dependent or a full-time student; people receiving long-term disability payments from a private insurer, an employer or the government; getting treatment for substance abuse; seven to nine months pregnant or pregnant at any stage with a medical complication.

Unaddressed are folks who've diligently searched for work but can't find it, can't reach job centers because our transit system stinks, who are physically unable to work but haven't yet been judged disabled by the Social Security Administration -- a process disability attorneys warn can take years -- who've been, say, failed by a struggling school system that hasn't equipped them to find work, or are living with one of those aforementioned mental or physical health problems that may make it difficult for an individual to find work, but don't quite rise to the level of disability.

"Every one of these reasons to deny you healthcare kills people," Propson said. "It might only kill 10 people or 50 people or 100 people, but when there are delays in accessing health care, there are victims."

Propson is right. And when I think of those lawmakers -- some of whom like to think of America as a Christian nation, and can't get enough of religion when it comes to allowing adoption agencies to bar gay couples from adopting or denying women access to reproductive care, but do not seem motivated to help those in need -- I can't help but think of comedian Steven Colbert.

"If this is going to be a Christian nation that doesn't help the poor," Colbert said, "either we've got to pretend that Jesus was just as selfish as we are, or we've got to acknowledge that he commanded us to love the poor and serve the needy without condition -- and then admit that we just don't want to do it."

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