Associated Press
LITTLE ROCK, Ark. (AP) — Republicans
this past week began to realize their long-held goal of requiring certain
adults to work, get job training or perform community service in exchange for
getting health coverage through Medicaid.
Whether that's a commonsense approach
or an added burden that will end up costing many Americans their health
insurance will now be debated in states across the country considering the
landmark change to the nation's largest health insurance program.
To Medicaid recipients such as Thomas
J. Penister of Milwaukee, it's created uncertainty about their ability to have
health coverage.
He's been unemployed for the last
four or five years and has received Medicaid for the past two. He sees a
behavioral health specialist to deal with anxiety and said Medicaid has made a
big difference in his life.
Penister, 36, said he is not yet
ready to rejoin the workforce and is unnerved by the prospect of potentially
losing Medicaid. His state, Wisconsin, is one 10 that applied to the federal
government for a waiver seeking to implement work and other requirements for
single adults.
"Would it be advantageous for me
even to go into the workforce instead of me therapeutically transitioning to a
state where I'm actually ready to perform in the workforce?" he said. He
compared it to someone recovering from a car accident "and saying that in
order for me to give you this medication, you got to go to work. Well, I
can't."
Yet his story also helps make the
case for those who favor some type of commitment from working-age adults who
benefit from Medicaid, the state-federal health care program for poor and
lower-income Americans.
Wisconsin Gov. Scott Walker, a Republican, sought
federal approval for a work requirement last year and said it helps prepare
recipients to leave public assistance.
Penister's status is unclear, because
Wisconsin's proposed changes would exempt anyone diagnosed with a mental
illness or who is mentally unable to work.
Republicans say work and other
requirements will return Medicaid to its original intent — to act as a stopgap
until people can find work. They say it has expanded far beyond its basic
mission.
The program, created in 1965 for
families on welfare and low-income seniors, now covers more than 70 million
people, or about 1 in 5 Americans. It expanded under President Barack Obama's
health care law, with a majority of states choosing to cover millions more
low-income people.
President Donald Trump's
administration announced that it will allow states to implement certain
requirements as a condition of receiving Medicaid benefits. Generally, it will
mean that states can require many adults on Medicaid to get a job, go to
school, take a job-training course or perform community service to continue
their eligibility.
Ten states had previously asked the
federal government for the requirement waiver, and others are sure to follow.
On Friday, Kentucky became the first to have it approved. Gov. Matt Bevin, a
Republican, called the new requirement "transformational."
Bevin has said he expects the move to
save the state more than $300 million over the next five years in Medicaid
costs. But he also estimated that as many as 95,000 Kentucky residents could
lose their Medicaid benefits, either because they will not comply with the new
rules or will make too much money once they begin working.
Critics of the policy shift point to
the number of people who could lose coverage, even if they meet the new
requirements.
"We just have concerns that a
lot of people who still are legitimately eligible, who do meet the work
requirement, will end up falling off the rolls because they don't know how to
verify or there's a technology glitch," said Marquita Little, health
policy director for Arkansas Advocates for Children and Families.
In Arkansas, the work requirement is
among several new restrictions the state has proposed for its hybrid Medicaid
expansion. About 285,000 people are on the program, which uses money from
Medicaid to buy private health insurance for low-income people.
Supporters of the work requirement
cast it as a way to move more people into the workforce and eventually off the
program.
"These are people that are
either underemployed or do not have sufficient training, and this is a
mechanism to put into place to make sure that the health care coverage is
really a bridge to training and better employment," Arkansas Gov. Asa Hutchinson,
a Republican, told The Associated Press. "I think it really fits in with
the goals of our state in increasing our workforce and training our
workforce."
States face limits on how far they
can go. The administration has said states should exempt pregnant women, the
disabled and the elderly, and that they should take into account hardships for
people in areas with high unemployment or for people caring for children or
elderly relatives. States also have to make accommodations for people in
treatment for drug and alcohol problems.
Arkansas' waiver request to the
federal government says it would require childless, able-bodied adults on
expanded Medicaid between the ages of 19 and 49 to work 20 hours a week or
participate in other activities such as job training or volunteering.
In Maine, where Republican Gov. Paul
LePage is pushing for a work requirement, Democrats are deriding the idea as
essentially a political stunt to punish the poor.
"They aren't about getting
people back to work. Instead, it's a political move to take health care away
from people who have already fallen on hard times," Democratic House
Speaker Sara Gideon said. "The reality is that Medicaid supports work, and
the sooner Governor LePage and the Trump Administration realize this, the
better."
Ehlke reported from Milwaukee.
Associated Press writers Scott Bauer in Madison, Wisconsin; Adam Beam in
Frankfort, Kentucky; Kelli Kennedy in Fort Lauderdale, Florida; Bruce Schreiner
in Louisville, Kentucky; and Patrick Whittle in Portland, Maine contributed to
this report.
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