What the GOP plan would mean for Medicaid work requirements

WASHINGTON (AP) — More than half a million of the poorest Americans could be left without health insurance under legislation passed by House Republicans that would require people to work in exchange for health care coverage through Medicaid.

It’s one of dozens of provisions included in a GOP bill that would allow an increase in the debt limit but curb government spending for the next decade. However, the bill is unlikely to become law. It is being used by House. republicans draw democrats to the negotiating table and avoid defaulting on the debt.

Democrats have strongly opposed Medicaid’s work requirement provision, saying it will discourage people from getting a job and increase the number of uninsured people in the country.

Here’s a look at how the proposal could save taxpayers money but cost some Americans access to health care coverage.

The work requirements say that able-bodied adults ages 19 to 55 who don’t have children or other dependents will need to work, train for a job, or perform community service to stay on Medicaid. They would have to put in at least 80 hours a month to stay in government-sponsored health care coverage.

About 84 million people are enrolled in Medicaid, and the Congressional Budget Office estimates that 15 million would be subject to the requirement. The Department of Health and Human Services, however, predicts millions more —about a third of the affiliates in total— would be forced to work.

Republicans say the measure would help push Americans into jobs that could eventually put them in a position to opt out of government aid.

The requirements would also be more equitable for those who work to support their families, said House Majority Leader Steve Scalise, R-Los Angeles.

“That single mom who is working two or three jobs right now to make ends meet in this tough economy, she doesn’t want to have to pay for someone who is sitting at home,” Scalise said.

Democrats argue that the job requirements could also unfairly kick people out of Medicaid.

Some people were wrongfully kicked out of Medicaid in Arkansas when they the state briefly introduced work requirementsChiquita Brooks-LaSure, administrator of the Centers for Medicare and Medicaid Services, told lawmakers. In some cases, people were not required to work but did not complete the required paperwork.

“It’s not just the people who are subject to the requirements who often get caught up in red tape,” he said. “It can often be people who are exempt.”

Approximately 1 in 4 people who had to work lost coverage during Arkansas’ experience with labor requirements in 2018.

Work requirements can put Medicaid enrollees in a bind. While no one has been kicked out of Medicaid in the last three years because of the pandemic, that changed in April when the federal government required states to review the income eligibility of all enrollees to see who now makes too much money to qualify for health care benefits. .

People who have looked for work, earned a small raise, or changed jobs are finding that that new income could soon cost them coverage.

Amy Shaw, 39, of Rochester, New Hampshire, lost her family’s Medicaid coverage in April because of her husband’s 50-cent raise to $17 an hour at an auto parts store. Shaw would not be subject to the GOP work requirement because she has two daughters, but the family’s case illustrates how modest income can take people out of Medicaid coverage and cost them dearly.

Suddenly, instead of a $3 copay, she was billed $120 for a cancer screening ordered by her doctor. Meanwhile, her rent has increased by 40% since the pandemic began, and the cost of food, utilities and other essentials has increased.

“It seems like the system is set up so you don’t want to go back (to work) because you lose more than you win,” Shaw said. “It makes me not want to go for my mammogram and colonoscopy. I don’t even want to go on these dates because it’s going to cost a lot of money.”

That largely depends on how many people who would be required to work choose not to or complete the proper paperwork to remain covered.

He Congressional Budget Office Estimates the requirements would save $109 billion over the next decade. Those savings would come in two ways: from about 600,000 people losing Medicaid, then 900,000 losing federal funding for their Medicaid but remaining enrolled in the program through their state.

That analysis also says the bill would do little to improve employment among Medicaid enrollees.

The Republican House bill will not pass a Democratic-controlled Senate or be signed into law by the President Joe Biden in its current state.

But don’t expect the problem of work requirements and cut Medicaid benefits to go away anytime soon. The number of people enrolled in Medicaid has skyrocketed in recent years, growing by more than 20 million since 2020.

If you ask the Democrats, that’s great: They’ve pointed to the record uninsured rate which has given more people access to health care. Democratic-led states have also come up with new ways to expand Medicaid under the Biden administration, granting more access to recently released convicts and new mothers, for example.

Republicans, however, want to reduce safety net programs to pre-pandemic levels. And, Republicans in some states are already trying to implement their own job requirements. Arkansas Governor Sarah Huckabee Sanders asked the federal government to approve a proposal that would move anyone who doesn’t meet the work requirements from private Medicaid insurance to traditional fee-for-service Medicaid.

Associated Press writers Holly Ramer in Concord, New Hampshire, and Kevin Freking and Lisa Mascaro in Washington contributed.