Under the planned new Health and Human Services regulations announced last week, waivers will be granted to states willing to restructure their programs to force individuals who would otherwise be eligible for Medicaid to workgenerally for about 20 hours a weekto qualify for coverage. So far 10 states have applied for the planned waivers: Arizona, Arkansas, Indiana, Kansas, Kentucky, New Hampshire, North Carolina, Maine, Utah, and Wisconsin. Most of the states recently expanded Medicaid eligibility standards under the Affordable Care Act, so those who newly gained coverage will be especially hard-hit. The plan purports to help the poor economically and health-wise, but its almost certain to make people poorer and sicker instead. Nationwide, the changes are expected to drastically reduce enrollment, arbitrarily denying millions of impoverished people access to life-saving medical services.
Anti-poverty and health-care advocates say the waivers, which enable state Medicaid programs to mandate employment for all so-called able-bodied adults, are not only cruel but irrational: The vast majority of working-age Medicaid recipients (excluding the elderly and people with disabilities) currently are already employed anyway. Those who arent are often facing severe employment barriers precisely because of poor health. According to the think tank CLASP, over one-third of working-age Medicaid recipients not working are unemployed because of illness or disability.
Making the poor work for health care may seem absurd, but it actually reflects a core idea of the conservative agenda to shrink the welfare state. Although historically, Medicaid was designed as a social protection for the most vulnerable, the new rules undermine the moral premise of the system by imposing a price on the right to health. Echoing the work mandates imposed under Clinton-era welfare reform, linking employment to means-tested federal benefits is a proven way to both reduce enrollment and further entrench poverty. Since those reforms of the late 1990s, hundreds of thousands of working families have been shoved off the welfare rolls, yet remain trapped in dire poverty.
While the job requirements for welfare arguably had the aim of encouraging productive workforce participation, disciplining the poor by tying jobs to health care is even more punitive, since it probably will improve neither their health-care access nor their economic conditionsbut instead just make them both poorer and sicker.
Those who would be forced to find work as part of the administrations work requirements will likely be tracked into low-wage jobs that simultaneously lack employer-sponsored benefits and leave them ineligible for Medicaid, according to a Community Catalyst analysis: Essentially, they would make too much to qualify for Medicaid, but still not get any benefits from their boss. These workers would also fall into an ever-widening coverage gap: too rich for Medicaid, too poor for subsidized insurance the federal health-care exchanges. In the case of an able-bodied worker with a minimum-wage job, supporting a two-person household (for example, a single mom with a child), they would be excluded from Medicaid in all but five states. Even a two-income household with two kids, with both parents earning their states minimum wage, would only qualify for benefits in South Carolina, Tennessee, and Wisconsin. So in nearly every community nationwide, the poor would be triply punished by a combination of harsh Medicaid restrictions, exorbitant insurance costs, lack of decent job opportunities, and regressive minimum-wage policies.