RED ALERT: Medicaid Work Requirement seen prowling around MI state legislature


Time: D H M S

h/t to Annette Prentice for the heads up on this. Via Michigan Public Radio:

State Senate introduces bill to add work requirements to Medicaid

The bill would require able-bodied adults to work or be in school for 30 hours a week in order to receive Medicaid.

Some lawmakers in Lansing want people to work to get Medicaid. The Senate introduced a bill Thursday. It would add work requirements to the Medical Assistance Program, or Medicaid.

...If passed, able-bodied adults would be required to work or continue school for 30 hours per week as a condition of receiving medical assistance.

There’s a similar bill in the state House. It’s been waiting for a committee hearing since December.

Opponents say there shouldn’t be more restrictions on health care – which they say is a human right.

The House version of the bill referred to was introduced by Klint Kesto and five other Republican state representatives, so you can figure out the rest.

Michigan's House and Senate are both GOP-controlled, and they ram through pretty much whatever crappy bills they want to, so there's no doubt in my mind that this bill will pass both; Michigan legislative Republicans have mostly become just as soulless as the rest of their party. The only potential hope here is that Governor Rick Snyder might veto it.

For all of his sins (and God knows there's many...just ask the people of Flint, for one obvious example), Snyder not only supported expanding Medicaid, he even supported having Michigan set up our own ACA exchange back in 2012-2013 (this effort was eventually scrapped, unfortunately). Snyder has repeatedly crowed about the success of our ACA Medicaid expansion program ("Healthy Michigan"), which currently has over 670,000 Michiganders enrolled in it...and again, as much as I trash him on other issues, I give him full credit where due, and this is one of those. In addition, Snyder is not only term-limited...he's actually out of office in less than 10 months, and he's a billionaire, so the GOP doesn't have a whole lot of leverage over him personally or professionally.

According to this Detroit News article:

Republican Gov. Rick Snyder has not yet taken a position on Medicaid work requirements, but [Republican State Senator] Shirkey said he has had multiple conversations with Snyder’s office about his legislation, which he formally introduced Thursday afternoon.

I'll say this, however: This is about to turn into a major campaign issue for the 4 Democratic candidates running to replace Snyder (not so much for the Republican candidates, I presume, since I guarantee all of them will be in lockstep with their legislative colleagues on it). Former State Senator Gretchen Whitmer, who worked with Snyder while she was in office to get Medicaid expansion passed in the first place a few years back, will no doubt have plenty to say about this will former Detroit Health Director Abdul El-Sayed (a Bernie Sanders-style Single Payer advocate), as will businessmen Bill Cobbs and Shri Thanedar. It's also going to become a major issue for candidates running for the state legislature, of course.

ONCE AGAIN, as I wrote back in 2015:

...aside from the fact that adding all of these extra requirements (ironically the same sort of "bureaucratic red tape" which conservatives supposedly hate) tends to overcomplicate what is historically an extremely efficient program (according to the Kaiser Family Foundation, Medicaid's administrative costs are only 7%, about half the rate of private insurance), there's another, uglier issue which is addressed by Joan McCarter over at dKos:

Most of these people are already working, assholes. How about instead of trying to embarrass them further for being poor, you work on embarrassing their employers for refusing to provide them health insurance or refusing to pay enough that they can buy it with Obamacare subsidies? And why isn't the fact that most people who would qualify for Medicaid who are now in the gap are working the beginning point in any discussion about Medicaid expansion and work requirements?

To Politico's credit, they do report (about 15 paragraphs in) that the majority of these people work, and add that among "those who don’t work, about a third said they were taking care of a home or family member, 20 percent were looking for work, and 17 percent were mentally ill or disabled." They point out that those numbers are close to the national labor force participation rate. There's a reason why this population is called the "working poor." Because they are working!

The graph accompanying the KFF report states that 43% of those still in the Medicaid Gap (about 3.8 million total) work full time and 23% are working part-time, or 66% of the total (the Politico article cites 57% from a March 2014 survey...but that one applied to the full 14.4 million people who could potentially enroll in Medicaid if every state expanded the program).

...In any event, that leaves 34%. 1/3 of that is around 11% of the total, 1/5 of it is about 7%, and 17% = around 6%.

In other words, only about 10%--at most--of those still in the Medicaid Gap appear to match the GOP's cliche of a "lazy, good-for-nothing layabout" type who's able-bodied, has no serious extenuating circumstances and so forth. The "get off your ass and work!" requirements appear to be nearly as big a waste of time and resources as the infamous "drug testing for welfare recipients" bandwagon which a bunch of states jumped on board over the past few years.

...Basically, Republicans have gone from saying "screw the poor" to "OK, you can see a doctor but only if you dance for me first."

Sure enough, according to the Detroit News article:

About 49 percent of residents enrolled in the Healthy Michigan program already have jobs, and 11 percent can’t work due to issues like serous physical or mental health conditions, according to a recent study by researchers at the University of Michigan. About one in four are out of work, but many suffer from poor health or impairments.

The Michigan League for Public Policy, a nonprofit focused on economic equality, says Medicaid work requirements would burden residents in need and could cost the state more than it would save.

“Too often we see politicians burdening Michiganders in need with harsh requirements and confusing red tape,” league president and CEO Gilda Jacobs said in a statement.

Yup. No more than 25%, and again, when you remove students and those who are caring for amily members/etc, you're likely down to perhaps 10% who could even remotely be considered among the "lazy ass" contingent.

And sure enough, just as I predicted three years ago, mandated Medicaid work requirements cost the state FAR more to administer than they actually save:

Bevin's Medicaid changes actually mean Kentucky will pay more to provide health care

Within Gov. Matt Bevin's complex plan to reshape the state Medicaid program to cut costs and hold people accountable is this fact that may surprise some Kentuckians:

Under Bevin's plan, it actually will cost Kentucky more to provide health coverage to people affected by the Medicaid changes than if the state did nothing.

Cost savings come from the assumption that nearly 100,000 people will drop out of Medicaid by the end of the five-year project recently approved by the federal government. For those who remain, the monthly cost of care increases faster than it would have had the state made no changes, according to the administration's projections.

"You're spending more money to cover fewer people," said Dustin Pugel, a policy analyst for the Kentucky Center for Economic Policy in Berea and a critic of the Bevin plan. "I'm not crazy about the idea of us spending more money to cover fewer people."

Meanwhile, Kentucky plans to spend close to $374 million over the next two years — most of it in federal money — to launch the plan starting July 1.

It has added $186 million to the current budget and proposes $187 million in the next budget year starting July 1 for administrative costs, most of the money associated with the Medicaid changes. Part of the administrative costs added to this year's budget would go toward creating a Medicaid computer system required by the federal government.