'I have
pre-existing conditions. But all they could tell me was, 'sorry, you didn’t
comply,'' said one Arkansan who lost coverage.
12/30/2018
07:29 AM EST
CABOT,
Ark. — Arkansas is throwing thousands of people off its Medicaid rolls each
month for not complying with work requirements, blindsiding vulnerable
residents panicked about losing their health coverage.
Views
differ on the fairness of the unprecedented social experiment, but there’s
unanimity here that it’s causing confusion. And that’s feeding a philosophical
debate about whether low-income adults are ducking the work rules or just can’t
navigate the tech-heavy reporting system that goes offline every night at 9
p.m.
Republican
Gov. Asa Hutchinson defended the program, saying it provides the help residents
need to become independent. “These are not people that didn’t want to work,” he
said in an interview. “It’s just they might not have had the training they
needed, or they didn’t have a job opportunity and they needed additional
assistance. And that’s what the objective is of the program.”
The state
has removed more than 16,000 low-income adults for failing to log at least 80
hours of work, job training, volunteering or similar activity — including 4,655
in November.
Some of
the people thrown off the program describe a nightmarish, confusing experience
with clunky technology and no one to help them. Individuals who don't adhere to
the new rules for three months get removed from Medicaid for the rest of the
year.
“I have
pre-existing conditions. But all they could tell me was, 'Sorry, you didn’t
comply,'” said Jamie Deyo, who lost coverage and suffers from rheumatoid
arthritis and back problems stemming from a 2013 car accident. “It just was a
slap in the face.”
Deyo is
one of nine Arkansas Medicaid enrollees who sued the Trump administration in
August to block the rules. She said a state letter notifying her about the work
requirements was sent to the wrong address, leaving her completely unaware of
the new terms. After losing coverage, the 38-year-old was unable to go to
physical therapy or see her doctor to schedule surgery to repair a broken screw
in her back. She’s also had to pay more for medication.
“A lot of
people don’t realize how bad I hurt,” she said. “I can’t stand up a lot. If I
could work, I would.”
The Trump
administration is using work rules to cut enrollment in the safety net program
after the Affordable Care Act expanded it to millions of able-bodied low-income
adults. Arkansas — which imposed rules in June on certain enrollees age 30 to
49 and plans to expand them in January to those age 19 to 29 — provides the
first real-time results of the GOP’s push to reshape the entitlement.
The Trump
administration has approved similar rules in Indiana, Kentucky, New Hampshire
and Wisconsin, but they haven’t taken effect yet; Kentucky’s have been stalled
by a lawsuit from advocates for the poor.
Arkansas
officials are belatedly making accommodations for people in a poor state with
limited internet access after national backlash from health care advocates,
including a new phone line for enrollees to report their hours.
Online
reporting kiosks have also been available at county offices. But the state has
not hired additional workers to help Medicaid enrollees navigate the new rules,
despite the high stakes for non-compliance.
Only
1,428 low-income adults required to report their hours in November logged at
least 80 hours. Roughly 8,400 failed to report 80 hours, with 98 percent of
them not reporting any work activities, according to statistics from the
Arkansas Department of Human Services.
Arkansas’
Medicaid experiment has drawn ire from Democrats across the country as well as
from a panel of Medicaid experts that advises Congress, which in November asked Health and
Human Services Secretary Alex Azar to stop the state from dropping people until
outreach efforts are improved.
Racheal
Holmes said she lost her benefits at the end of October despite going to a
Department of Human Services office in Little Rock once a month to log her
hours.
Holmes,
who had been working at a grocery store, said it took hours just to log in to
the online reporting system the first time. A state worker offered help only
after a security guard noticed she was still at the office after several hours,
she said.
“You
couldn’t get basic assistance, as though it’s a way for you to fail,” said
Holmes, who is currently unemployed and has been unable to afford medication to
treat high blood pressure since her coverage lapsed. She doesn’t think the work
requirements are unfair but asks, “Where’s the assistance?”
Arkansas
officials point to what they describe as promising signs the requirements are
working but haven't finalized plans to see whether the project is achieving its
goals of helping individuals find work and improving their health.
More than
3,800 Medicaid enrollees who were subject to the work rules have found jobs
since June, although it’s unclear how many of them were motivated specifically
by the new requirements.
Hutchinson
scoffed at critics who say the state isn't doing enough, citing examples such
as the Department of Human Services making more than 155,000 phone calls to educate
enrollees about the rules. The state is also planning a new advertising
campaign.
“You
could show that it was 100 percent successful in every way and they would still
criticize it, because they don’t believe that any responsibility should have to
accompany a social benefit such as Medicaid,” Hutchinson said. “The criticism
is based upon myths and misunderstandings and a totally different philosophy.”
Hutchinson
fought with legislators in his own party to continue the Medicaid expansion his
Democratic predecessor began under Obamacare, which now covers more than
230,000 people. The governor maintains that the work requirements are a needed
conservative counterweight to the health law's coverage expansion in a red
state where there’s little desire to enlarge the social safety net.
A
supermajority of three-fourths of the Arkansas House and Senate is required to
approve funding for Medicaid expansion each year, leading to almost annual
cliffhanger votes.
Hutchinson's
push to institute conservative changes has given Democrats and advocates for
the poor heartburn, with critics arguing Medicaid was never intended to be a
jobs program. Conservatives disagree.
“It is
reasonable and expected in the United States of America and especially here in
conservative Arkansas that people who are able to work will do so,” said state
Sen. Jason Rapert. “It is not acceptable for people to think they are entitled
for other taxpayers to pay for services for them just because they do not want
to work. That is not individual responsibility.”
In an
interview earlier this month, Rapert said he hadn’t heard a single complaint
from constituents subject to the work requirements.
But
residents tell other stories. Casey Copeland, a 37-year-old who struggled with
depression and drug addiction following the death of his father, said he's able
to comply with the rules only by volunteering in the community and relying on
financial support from his family.
“If my
mom didn’t support me on the financial stuff, I couldn’t do all of it,” he said
in an interview at Canvas Community Church in Little Rock, which holds a weekly
dinner-and-a-movie gathering for the homeless.
Copeland
was able to report his hours online using a computer at home but said the
process was “very confusing.”
Department
of Human Services Director Cindy Gillespie said officials are looking at the
program “continuously” to see how it can be improved for enrollees.
“We’re trying
to help them get to a lot of the things that exist in this state,” she said.
“We’re trying not to really be fixated on what everybody else is saying outside
Arkansas about the program.”
That's
not much consolation for Deyo, who's figuring out how to deal with her
infirmities in the new landscape.
“I have
the doctors‘ notes that say I can’t work; I have their signatures,” she said.
“Nobody wanted to hear that from me."
https://www.politico.com/story/2018/12/30/conservative-health-care-experiment-leads-to-thousands-losing-coverage-1076876?utm_campaign=AIS%20Health%20Daily&utm_source=hs_email&utm_medium=email&utm_content=68735754&_hsenc=p2ANqtz-_knpbq5isQz3Fd2qsWpv5tN_mSwB7HbqexxSwNa9nsDRr6QlipJpsHiqYZB4ejyl9d7PRm1Ne5wxqhRlpYSELT3iYVsw&_hsmi=68735754
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