Key Takeaways:
* Arkansas became the first state to require some Medicaid recipients to work, volunteer, or get education in 2018.
* The policy led to 18,000 adults losing their coverage before it was halted in 2019.
* Under the Trump administration, 13 states received permission to impose work rules on some Medicaid recipients.
* As Trump makes a comeback, many states are likely to reintroduce such laws.
* Republicans aim to reduce federal spending by about $109 billion over a decade through such policies.
Back in 2018, when Arkansas applied a new rule on Medicaid recipients, life became too frantic for many. The rule required recipients to work, volunteer, go for schooling, or participate in job training to continue receiving the benefits. However, for recipients who were either not healthy enough or caring for unfit family members, this meant just one thing — a threat to their Medicaid coverage.
When Rules Impact Health Coverage
People who did not meet these criteria started losing access to their healthcare plans. The result — they either had to maintain their diminishing health with no coverage or keep hoping to recover and work again. Sadly, by 2019, about 18,000 adults had already lost their coverage under this policy.
Interestingly, Arkansas wasn’t alone in this game. During the last Trump administration, 13 states, including Arkansas, received the green light to impose work requirements on some Medicaid recipients. Moreover, nine additional states sought permission for similar rules but did not receive approval before Trump’s term ended.
The Return
When President Biden took over the office, he withdrew all these approvals. However, with Trump staging a comeback, states are likely to reattempt imposing the rules — this time, with a supportive U.S. Congress on their side.
Republicans are excited about ways to finance tax reductions adopted during Trump’s previous term. They have their eyes set on Medicaid, which is jointly funded by the federal government and the states. Implementing work rules on Medicaid could drastically reduce federal expenditure by an estimated $109 billion over a decade. According to the Congressional Budget Office, this is because the cost for about 900,000 people would be fully transferred to the states. And another 600,000 people might end up without insurance.
Rolling the Ball Yet Again
Before Trump’s victory, Arkansas had already started pushing the envelope. Republican Governor, Sarah Huckabee Sanders, sought federal endorsement to apply work rules to the able-bodied adults eligible under the state’s Affordable Care Act extension and enrolled in health plans via Arkansas Medicaid.
However, enforcing such rules might hurt more than benefit. A 2020 study found no proof supporting the policy’s stated goal of promoting work. Instead, it found substantial evidence of these rules causing damage to healthcare coverage and access.
Work Requirements: Help or Hurdle?
Those advocating for the work requirements argue that it promotes self-sufficiency and financial stability among Medicaid recipients. However, those opposing it claim the rules do more harm by causing people to lose coverage and delay necessary care.
Some already-effected states are keeping a cautious stance. For instance, even though Georgia already has work requirements in place for partial Medicaid expansion, the enrolment numbers are lower than expected. Resistance to the policy has increased, primarily due to administrative logistics. However, pro-legislation policy makers are determined to learn from past mistakes and push forward.
The discussion around work requirements for Medicaid recipients is far from over. As the political landscape shifts, we are likely to see this controversial policy resurface again. And as always, its consequences will deeply impact the recipients.