GOP Proposals Would Require Able-bodied
Adults to Hold a Job in Order to Qualify
for Medicaid
By
Amy Goldstein and Juliet Eilperin
March 17, 2017 "Information
Clearing House"
- "WP"
- A contingent of House Republicans is
trying to push the nation’s health
insurance program for poor and
vulnerable Americans deep into
conservative territory, past a firewall
that the Obama administration maintained
for eight years.
A
partisan vote Thursday afternoon by the
House Budget Committee would require
able-bodied adults to hold a job in
order to qualify for Medicaid. That
profound change has long been popular on
the far right as a way to promote
personal responsibility but opposed by
Democrats who fear it would deny health
care to many people who need it the
most.
Compelling people to work, which would
align Medicaid with a similar
requirement in the nation’s main welfare
program, was one of a trio of moves that
committee Republicans recommended as
they approved the legislation they hope
will begin to dismantle the Affordable
Care Act.
Over protests from Democratic lawmakers,
the panel also recommended that an
expansion of Medicaid under the ACA be
dismantled sooner than the GOP’s
proposed American Health Care Act
envisions. And committee members voted
that states should be able to convert
Medicaid from an entitlement program —
covering anyone who is eligible — into a
block grant, under which the federal
government would provide a state a fixed
annual sum and free it from federal
rules spelling out which people qualify
and what health benefits must be
provided.
Friday morning, President Trump declared
that he was “100 percent” behind the
work requirement and block-grant option.
The bill could be on the House floor
late next week.
The three votes on Thursday did not
formally alter the AHCA, which House
Speaker Paul D. Ryan (R-Wis.) and his
allies are trying to rush through the
chamber amid a political obstacle
course. The Budget Committee merely puts
forward changes to be considered at the
next stage before full House debate on
the legislation.
Still, the Medicaid recommendations
further highlighted the ideological
cross-pressures on Ryan — and the Trump
administration — in forging a set of
Republican health policies that might
pass both chambers of Congress. While
the House Budget Committee is trying to
nudge the program toward the right,
moderate Republican governors and
senators are fighting to ward off the
loss of millions of dollars in federal
aid to the 31 states, plus the District
of Columbia, that expanded their
Medicaid programs.
GOP governors from Arkansas, Michigan,
Nevada and Ohio sent their own
health-reform proposal on Thursday to
Ryan and Senate Majority Leader Mitch
McConnell (R-Ky.). The four had been
working behind the scenes on the
alternative proposal for some weeks with
several other Republican governors,
though these others did not sign onto
the public letter.
The current House bill “provides almost
no new flexibility for states, does not
ensure the resources necessary to make
sure no one is left out, and shifts
significant new costs to states,” they
wrote. As part of their proposal, the
governors urge Congress to preserve the
increased level of federal payments that
ACA provides for adults in the expansion
group — and, if necessary for fiscal
reasons, cut back on the eligibility
limits rather than cutting out the
higher reimbursements.
A
legacy of Lyndon Johnson’s War on
Poverty in the 1960s, Medicaid always
has been a shared responsibility of the
federal government and states. The
current tug of war is likely to shift
that balance as well as affect how
generous the program will be in the
future.
For now, the House GOP’s health-care
plan would provide each state a fixed
sum for each beneficiary — no matter how
much or little of the costs that funding
covered. Committee Republicans would add
an alternative to that per capita
approach, and the block-grant option
would give states more leeway to reshape
Medicaid, according to Diane Rowland,
executive vice president at the Kaiser
Family Foundation. But block grants
“would no longer provide the safety
valve to increase federal funds to
support Medicaid during recessions or
other surges in enrollment.”
The legislation also would allow the
expansion states to keep enrolling
people until the end of 2019, and the
government would continue paying for
nearly all their costs. After that, the
government would not provide the higher
funding level for anyone new on the
Medicaid rolls, presumably prompting
most states to retreat to their previous
income thresholds.
Rachelle Schultz, president and CEO of
Minnesota’s Winona Health, said Friday
that many of the patients her hospital
serves could lose their coverage.
“If the Medicaid cuts go through,
essentially, these people have no
insurance,” Schultz said during a
Washington roundtable organized by the
American Hospital Association. The
consequences will ripple outward, she
added, since uninsured people often
postpone treatment for chronic
conditions until a problem worsens and
requires more costly care. “What happens
is they stay home, and they show up at
the emergency room.”
The budget panel went further than the
current bill, recommending that the
extra funding end right away. Calling
Medicaid’s expansion “a cruel joke”
because not everyone who joins can find
doctors, Rep. Matt Gaetz (R-Fla.) said
that waiting until 2020 “would be like a
diet strategy, if I said I needed to
lose weight but [would] start 2½ years
from now and in the meantime eat
everything in sight.”
Rep. Debbie Wasserman Schultz (D-Fla.)
countered, “That is simply code for deep
cuts and fewer people covered.”
The sharpest exchange Thursday was over
requiring able-bodied adults on Medicaid
to hold or train for a job. Republicans
suggested that such a requirement would
save the government money and encourage
those in the program to take greater
responsibility for their own lives.
“Let’s prevent idleness,” said Rep.
Jodey Arrington (R-Tex.), who contended
that requiring people to work would
“make this not so much of a seductive
entitlement.”
|
Not
For Profit - For Global Justice - Since 2001
|
Rep. Jan Schakowsky (D-Ill.) responded
by saying that “most people on Medicaid
who can work, work” and that
Republicans’ “ultimate goal is to simply
kick people off Medicaid, and not
actually help people find employment.”
Medicaid now covers some 68 million
low-income Americans, including
children, pregnant woman, people who are
older or disabled, and others who are
merely poor. About 11 million of those
beneficiaries are people with somewhat
higher incomes who joined in the past
three years through the ACA expansion.
A
Kaiser analysis last month found that
eight in 10 adult Medicaid recipients
live in working families — and 59
percent who are not disabled have a job.
Most who do not work have major
obstacles, such as an illness or
disability or caregiving responsibility
for a relative, and nearly one in five
are in school.
During the Obama administration, at
least a half-dozen states sought
permission to include work or
job-training requirements as part of
their Medicaid programs.
The requests ran the gamut: Indiana
wanted to hinge eligibility on a work
referral, while Arizona proposed that
able-bodied adults work, seek work, or
attend school or job training for at
least 20 hours a week. Arkansas would
have made Medicaid beneficiaries meet
the same work requirements as welfare
recipients, and Pennsylvania, Ohio and
New Hampshire variously hoped to require
part-time work, participation in a job
training program or proof that a person
was training for work.
In
each case, the request was denied.
Many health industry officials say they
remain confident the House legislation’s
provisions for Medicaid will be
significantly altered once the Senate
weighs in.
“In many instances — not just with
health care — the House does one thing,
and the Senate tends to be a tempering
institution,” Tom Nickels, the hospital
association’s executive vice president
for government relations and public
policy, said Friday.
