September 25, 2018 | ° F

WASSERMAN: Mandatory work for Medicaid is bad move


Opinions Column: A Healthy Dose of Justice


JakeWasserman

Hello again, Rutgers. Whether you are just starting as a new student here or you are a veteran Daily Targum reader, thanks for clicking or picking up a copy of the paper on this first day of the Spring semester. Like many of you, over my winter break I attempted to do that elusive thing called “relaxation,” but unfortunately I am an anxious millennial living in a country run by a petulant child-king, in what could be the last days of the freedom of the press (or human existence … you can never really be sure, these days), so that did not really work out too well. As a certified public health nerd with a penchant for social justice, there was one particular news happening that really irked me, and I am using this issue of my column to amplify the indignation that I believe our country should rightfully hold.

On Jan. 11, the President of the United States ruled by decree that states now have the right to make work requirements for able-bodied adults to participate in Medicaid. In a Draconian departure from the Affordable Care Act’s (ACA) option for states to expand Medicaid coverage, the Trump administration’s new rule is a conservative win towards rolling back the social insurance program for low-income people started under former President Lyndon B. Johnson's administration. Although not necessarily stringent on the definition of “work," the Trump administration stated their support for states making requirements of employment or “community engagement activities” that could include volunteering, job training, searching for a job or going to school for Medicaid eligibility, although that definition is left to the discretion of states.

Seemingly packaged in a benevolent gift wrap, Centers for Medicare and Medicaid Services (CMS) administrator Seema Verma has stated that the move is designed to respond more flexibly to the specific needs of states’ public health issues, while incentivizing working-age adults to enhance their employable skills. But the Trump administration’s move points to a greater epistemological issue in the conversation of our public health: does requiring people to work actually make them healthier? The evidence says no. According to a 2016 study from the Center on Budget and Policy Priorities, work requirements as a means of health improvement were not found to be highly effective, and that requirements do little to reduce poverty, sometimes even pushing families deeper into it. Studies from Ohio and Michigan’s Medicaid programs even suggest that the Trump administration’s thinking is entirely backward, and that it is having Medicaid that has allowed people to be healthy enough to get jobs.

According to the Kaiser Family Foundation, two-thirds of Medicaid recipients are seniors, children or disabled adults, with the 79 percent of the remaining one-third living in families with at least one working person, and 64 percent having full-time jobs themselves. So in addition to the incorrect logic about how health is achieved in the industrialized United States, the new modification to require work for Medicaid is attempting to solve a problem that does not exist. Without a data-driven necessity to make this change, we can only interpret this as another GOP chess move to undermine the ACA through its Medicaid expansion. In addition, this move would have profound effects in exacerbating current public health issues, such as the opioid crisis, in which people with severe addictions cannot hold down long-term employment, as well as disadvantaged adults with chronic conditions who do not qualify for disability, but are still unable to work or volunteer.

Since the Trump administration’s announcement last week, Kentucky’s plan for instating work requirements has been approved and is slated to begin in July of this year. Gov. Matt Bevin celebrated the plan, calling it “the most transformational entitlement reform that has been seen in a quarter of a century,” with around 350,000 Kentuckians subjected to the requirement. Kentucky’s provisions also include a monthly premium for Medicaid enrollment, ranging from $1 to $15 depending on income level, a provision that disenrolls people for six months if they fail to report a change in employment or income, and a change that requires recipients to now “earn” previously included dental and vision benefits through financial literacy courses or receiving a GED. With the ACA’s Medicaid expansion, Kentucky’s uninsured population has decreased more dramatically than almost any other state, but the Bevin administration is proud of the fact that this move will result in 100,000 fewer Medicaid recipients over five years. Multiple health activist groups are considering legal recourse against the Bevin administration’s change to the state Medicaid program.

If America is to properly work towards reducing poverty, increasing the health of our population and promoting prospects for employment in the 21st century, it might be best to back our public policy with statistically sound evidence and morally righteous sentiment. The moves by the Trump and Bevin administrations should not come as a surprise, given the entirety of GOP policy pursuits in 2017, but America should be angry, and America should fight back before more states pursue policies that hurt our most disadvantaged people.

Jake Wasserman is a Bloustein School senior majoring in Public Health with a minor in Cognitive Science. His column, “A Healthy Dose of Justice” runs every alternate Tuesday.

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Jake Wasserman

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