Upshot extra: Medicaid work requirements edition

My Upshot post today is about health and financial literacy courses in Kentucky’s new Medicaid program. An earlier draft had more content about its work requirements. Those paragraphs were cut to focus the piece. Here they are:

Proponents of Kentucky’s approach say work requirements will help Medicaid enrollees. By analogy with food stamps and cash assistance programs that have included work requirements in some states, they argue that encouraging work will reduce Medicaid enrollment. Another advantage they cite is that it would combat needless idleness among adults capable of working. It may also address a perceived inequity, whereby working individuals who make just enough not to qualify for Medicaid have to pay more for health insurance than do Medicaid enrollees who need not work at all.

Ron Haskins, a senior fellow for economic studies and co-director of the Center on Children and Families at the Brookings Institution, advocates affording states flexibility to reform public policies, including Medicaid, to include requirements to work for those who are capable of doing it. “Labor force participation among 25-54 year old men has been declining for decades,” he said. “It has plateaued for other groups more recently, with important consequences for personal finances as well as identity.”

But many health policy experts are not enthused with Kentucky’s program. Some worry it will drown Medicaid enrollees in paperwork, causing many to lose coverage if they get wrapped up in red tape. It would take considerable effort for modest potential gains. Only about one-quarter of Medicaid enrollees in states that have expanded the program under the Affordable Care Act are not working but are capable of working.

“Anger about Medicaid is not surprising. We have taxpayers with jobs that provide no health coverage paying for poorer people to have coverage they couldn’t dream of — with no premiums, copays, or deductibles,” said Atul Gawande, a surgeon and professor with the Harvard T.H. Chan School of Public Health. “This is bound to create bitterness about who is deserving and who is not. The solution isn’t to cut more people off.  That won’t soften the anger. What would is opening up Medicaid more widely, like Medicare. We don’t have these debates about Medicare because everyone contributes as they are able and everyone benefits.”

“Work is an important goal. Health care is an important way to ensure that people can be well enough to work. Refusing health coverage to people unless they work is a proven recipe for more sick people, not more work,” Dr. Gawande said.

The piece is far better with these left out. Go read it!


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