This article is based primarily on actions in Idaho a very “red” state but typical of other very conservative states across the US.
Scapegoats tend to be people considered expendable. Are people who need Medicaid expendable? The word “scapegoating” originated from an ingenious ritual described in the Bible. According to Jewish law, the high priest laid hands on an “escaping” goat, placing all the sins of the Jewish people from the previous year onto the animal. Then the goat was beaten with reeds and thorns, driven out into the desert, and the people went home rejoicing. Violence towards the innocent victim may be effective at temporarily relieving the group’s guilt and shame. Are Medicaid work requirements our current “scapegoating” for our neglect in ensuring healthcare for people? Do our legislators view Medicaid recipients as undeserving of medical help? A majority of Idahoans disagreed when the Medicaid Expansion was voted in a few years ago.
Idahoans are eligible for Medicaid expansion if they earn less than 138% of the federal poverty level which is $21,597 annually for a single person, or $44,367 for a family of four. The Idaho Medicaid expansion covers nearly 79,000 Idahoans. The CDA Press reported that researchers state up to 44% of Idahoans could be cut from the current enrollment based on legislation passed this session which includes work requirements. Some of our legislators say their goal is “to ensure people receiving Medicaid who can work are working.” According to the Urban Institute and the Robert Wood Johnson Foundation these “work requirements” could kick 20,000 to 34,000 Idahoans off Medicaid. The work requirement specifies people work for three months before applying for Medicaid. Many enrollees with unstable employment are in poor health, had irregular work schedules, experienced job loss, worked part time, lived with disabled household members. Only 2% of enrollees, neither working nor in school reported a lack of interest in a job as a reason for not working. Researchers find between 19% and 37% of people who already work could lose Medicaid coverage. Some meeting the work requirement face challenges, documenting their work activity. People who are self-employed, work irregular schedules, are students, caring for disabled family members or are 50 or older are at particularly substantial risk.
The Urban Institute reported the policy could prevent many working adults from enrolling or staying enrolled in Medicaid because of the employment instability prevalent in the low wage labor market. 69% of expansion Medicaid recipients without dependents work or attended school while enrolled in Medicaid. One in three who work or attended school would not have met the work requirement
The Idaho Center for Fiscal Policy reported that Idaho Medicaid Costs are Growing Slower than Other Parts of the State Budget saving money for Idaho’s taxpayers. Medicaid expansion savings exceed state costs for every year a full analysis is available. Medicaid expansion has generated ongoing state savings in corrections, drug courts, behavioral health, county indigent funds, and state catastrophic health programs. Medicaid expansion reduced the uninsured rate and reduced uncompensated care, putting downward pressure on the cost of medical care for everyone. Medicaid expansion in Idaho created 9,362 jobs throughout the state. It generated over $35 million in general fund revenue and $12 million in property tax revenue, for a combined total of $47 million in tax revenue for the state. These funds can be invested in public services for the people of Idaho – such as public schools, roads, and public safety.
Many may believe Medicaid is an unaffordable/unnecessary government entitlement program that helps those not eligible and those who elect to forego buying coverage for themselves and their families. The reality is that 60% of adult Medicaid enrollees work full-time or part-time, and access to affordable employer-sponsored coverage for them is not possible. If most Medicaid eligible people are working or are children, what is the rationale for our legislature adding work requirements. The fact is these people will work, but the requirements effectively create administrative barriers to the program. If I had to take time off work to renew my drivers license, would I put it off? Fortunately, I can renew through the mail. Otherwise, I might end up driving with an expired license but not losing my healthcare.
Voter support toward Medicaid is critical to its sustainability. Its future is inextricably tied to economic circumstances in individual states and the nation, and the mood of voters. Many legislators support these work requirements because in their mind able bodies people eligible for Medicaid do not want to work. The facts show something quite different. People on Medicaid are struggling to make ends meet without any extra money for a doctor’s office visit. Believing something false allows us to load those “undeserving” human beings onto a goat, any goat and shoo him away. Take a moment and consider who is hurt by this requirement. People are struggling financially and our leaders impose unwarranted requirements on their ability to obtain healthcare. I must ask why and by what right? We voted to help those less fortunate. We must provide hope through Medicaid.
Phil's Personal Perspectives 