Work Requirements Won't Improve Medicaid. A Jobs Guarantee Might. - The Atlantic - 0 views
-
The Trump administration has been signaling for months that it plans to implement conservative reforms to core federal welfare programs, including by allowing states to have work requirements for Medicaid. So it was no surprise on Thursday when the Centers for Medicare and Medicaid Services issued guidance for “state efforts to test incentives that make participation in work or other community engagement a requirement for continued Medicaid eligibility.”
-
So far, it’s unclear how widely adopted work requirements will be and how exactly states will implement them under CMS’s new guidance. On Friday, Kentucky was the first state to have its 1115 waiver creating work requirements approved by CMS. On Thursday, Verma noted that nine other states had already submitted waivers asking the federal government to approve incentives or requirements for some Medicaid beneficiaries. In addition to allowing strict job mandates, CMS will also allow requirements for “other community-engagement activities,” including volunteering, job training, and caregiving. (These rules only apply to specific adults; CMS carves out people with disabilities, the elderly, children, and pregnant women.)
-
Yet if states want work requirements to increase the health and self-sufficiency of Medicaid beneficiaries—their stated goal—most available data suggest they’ll fall short. As the Kaiser Family Foundation reported in 2017, most people on Medicaid who can work do work. Around 60 percent of adult enrollees have a job, and for the most part those who don’t report impediments in their ability to work. Even those who are not officially disabled often attest to having debilitating conditions—like severe back problems—that make full-time jobs difficult or impossible. Others may be in school, work as primary caretakers for loved ones, or may have retired.
- ...4 more annotations...
-
If those effects were repeated in Medicaid, it could prove disastrous for the health of the program’s beneficiaries. Especially in states that expanded Medicaid under Obamacare, work requirements could create a new underclass of people ineligible for any health insurance. That includes a large contingent of people with disabilities who don’t qualify for Supplemental Security Income and vulnerable populations like young men with felonies. Caught in a vicious cycle, those people would then be less healthy and less financially secure, and thus less likely to be able to work and make it out of poverty
-
Such a program would have its most drastic effects on wages, productivity, and reducing racial and class-based wealth inequality if it were implemented as a universal program. But it could probably achieve CMS’s goals of long-term health benefits and poverty reduction if it were instituted solely for current Medicaid beneficiaries. If the 4.4 million non-elderly adults who aren’t working; aren’t caregivers, retired, or students; and don’t qualify for disability insurance are used as a floor, providing jobs for them would cost a little more than Lowrey’s total of $158 billion, around 30 percent of Medicaid’s annual budget of over $550 billion. If people who self-report as ill or disabled are excluded from that number, Medicaid would need to pay for a maximum of 880,000 jobs, or $35 billion a year, 6 percent of the annual Medicaid budget.
-
A Medicaid jobs guarantee could serve to amplify both of those roles. It could essentially set a wage floor for Medicaid enrollees, who often work near the bottom of the wage scale and often barely crack the poverty line even while working full-time hours (or more). Integrating Medicaid into bespoke job structures for people with disabilities could provide transportation and rehabilitation, and further increase the accessibility of those positions, thus creating more synergy between health and employment.
-
Similar to how employer-sponsored insurance has become a backbone to the economic growth of the middle class, a jobs guarantee for Medicaid would take the largest health-insurance program in America and transform it into a nexus of anti-poverty policy and health equity. Put more simply: The easiest way to make sure people receive the health benefits of employment could be to employ them.