Republicans' Medicaid madness

Wednesday, May 9, 2018 - 6:59pm

Earlier this year, President Donald Trump’s administration told state Medicaid directors it would support states seeking waivers to impose work requirements for people covered by the public health insurance program— a partnership between the federal government and the 50 states plus the District of Columbia. So far, Kentucky, Indiana, Arkansas and New Hampshire have received these waivers and it is estimated over a million people will be affected by these work requirements.

In April, the Michigan state Senate passed their own Medicaid work requirement bill, Senate Bill 897, that would require “able-bodied” enrollees to document at least 29 hours of work, education or job training per week lest they lose their health coverage. Off the bat, I should note other states that have already implemented work requirements, or have asked for waivers to do so, set them at only 20 hours per week. So even by their fellow Republicans’ standards, S.B. 897 proposed by state Sen. Mike Shirkey, R-Clarklake, is extreme.

The bill is currently in the state House of Representatives and has the support of Speaker Tom Leonard, R-DeWitt. Luckily, Gov. Rick Snyder, whose one silver lining may be his support of Medicaid, believes this bill to be unreasonable and will likely veto it. However, according to Leonard, Shirkey is working with the governor’s office to make changes to S.B. 897. The only solution I can suggest is to burn the bill.

 

The logic behind Shirkey’s bill is simple enough to follow. Medicaid is expensive, costing Michigan 30.2 percent of its budget in 2016. Republicans’ solution? Use work requirements to force people off of the program. Under less-stringent work requirements like those in place in Kentucky, approximately 150,000 Michiganders would lose their Medicaid coverage resulting in a 15-percent reduction in enrollment. The impact of S.B. 897 would be even more devastating.

To be fair, there is an urgency in reducing the cost of Medicaid because the legislation that created the Healthy Michigan program, an expansion of Medicaid under Obamacare, has a provision that would shut the program down if net costs outweigh net savings. If that happens, Michigan will revert to pre-expansion Medicaid rules and thousands would lose coverage. However, just because work requirements are a solution does not make it the right solution for Michigan.

The basic logic behind work requirements, as far as I can tell, is that they will eventually lead people either to employer-based private health insurance or to a family income above 138 percent of the federal poverty line, the cutoff under Medicaid expansion.

While Obamacare did reduce the medically uninsured rate in this country, there is still the problem of the Medicaid coverage gap, an unfortunate circumstance where a person or family makes too much to qualify for Medicaid but not enough to qualify for Obamacare subsidies to help pay for private health insurance. And what about employer-provided health insurance? Well, that workplace benefit is rapidly disappearing (though state legislators may not have noticed seeing as they have coverage). Per the Kaiser Family Foundation, only 57 percent of surveyed employers in 2015 offered health insurance to at least some of their employees and expect workers to contribute, on average, 29 percent of the premium for family plans.

Furthermore, the nature of employment in America has become part-time; 6 million Americans have part-time jobs but want full-time employment. Twenty-five percent of part-time workers live in poverty and would likely qualify for Medicaid. Part-time work and the associated job insecurity also leads to worse mental health. Imagine adding the potential of losing Medicaid coverage or a family’s coverage to the mix. Chronic stress is linked to many physical health problems including cardiovascular disease. Conditions like diabetes can also worsen with stress. Programs like Medicaid are meant to improve health, not make people sick.

Even if work requirements did have a positive impact on people, how many people would be affected? According to the Kaiser Family Foundation, only 7 percent of Medicaid enrollees are not working for a reason other than disability, school attendance or caregiving. Furthermore, 25 percent of workers, such as seasonal workers, who would meet the 29 hours per week requirement on average would risk losing their Medicaid because they cannot meet the requirement every month. In another cruel twist to the already toxic bill, there is no exemption for caregivers of children up to thirteen years old despite the efforts of state Sen. Rebekah Warren, D-Ann Arbor, to amend S.B. 897.

But perhaps the biggest, reddest flag concerning S.B. 897 is the clearly racist provision that would exempt residents in rural, mostly white counties from the requirements. The provision states that counties with unemployment greater than 8.5 percent would be exempt from the work requirements. Sounds fine and not-racist, right? Well, let us conduct a comparison. Lake County is in western Michigan and is 87 percent white. In this county, the unemployment rate as of March was 9.2 percent, well within the range for exemption. On the other hand, in Detroit, which is 80 percent Black, unemployed people would not be graced with the same exemption because Wayne County writ large has an unemployment rate of only 5 percent. Same goes for other majority-minority cities like Flint, Saginaw and Benton Harbor. While I do not think that this provision to S.B. 897 was meant to be racist, it certainly is.

In summary, S.B. 897 will lead to poorer health for disadvantaged Michiganders who rely on Medicaid with particularly harsh impacts on seasonal workers, parents or guardians of children, and urban people of color. It is racist and classist.

I understand the need to cut down on Medicaid spending in Michigan but there are better alternatives. It is clear from the push for Medicaid work requirements and the earlier fiasco to repeal the Affordable Care Act that Republicans do not believe health care is a basic human right. It is up to vigilant voters to defend the health of our fellow Michiganders. S.B. 897 must be opposed.