Even as it continues to advance in the Legislature, a proposal to add a work requirement to Medicaid is meeting strong opposition from health care providers, counties and even some GOP legislators.
Supporters say that the Republican-sponsored bill is needed because Medicaid discourages "able-bodied" people from working, even at a time when the state is facing a workforce shortage.
"It will be one of the most cost-effective job bills that this Legislature has seen in years," said Sen. Mark Johnson, R-East Grand Forks, the lead author, who testified Thursday before a Senate health finance committee.
But critics say that the bill would cost the state and counties money, increase the size of government, overwhelm the state's workforce training programs, increase uncompensated health care costs in hospitals and clinics, and ultimately take away health care from people who need the treatment and stabilization that will help them get a job.
"You need health in order to work," said Sen. Tony Lourey, DFL-Kerrick. "Our investments in the health of Minnesotans pay tremendous dividends to our economy and our businesses in the state."
The Senate version of the bill advanced Thursday on a partisan vote, although Sen. Scott Jensen, R-Chaska, abstained from voting.
Jensen, a doctor, cited reports he heard from Hennepin County Medical Center, which estimated that 32,000 of its patients would be displaced. He also said the bill raises issues that need to be discussed. "But I don't think this bill should be a partisan issue," he said.
On Wednesday night, the House health finance committee narrowly approved the House version, with two Republicans voting no.
"The implementation of this bill is an absolute nightmare," said Rep. Nick Zerwas, R-Elk River. "I love the spirit of the idea of getting ahold of out-of-control costs, but this, members, this is not the path forward."
Rep. Rod Hamilton, R-Mountain Lake, also voted against the measure. Addressing one of the central issues of the debate — whether health care is a right or a privilege — Hamilton said, "That one is really easy to answer when you are healthy." Hamilton received a diagnosis of multiple sclerosis more than 20 years ago.
"If I am going to err as a legislator, especially on something that is this important, I am going to err on the side that helps those in need," Hamilton said.
Medicaid covers 1 million Minnesotans, and more than half of them are children. The elderly and disabled would also be automatically exempted from work requirements.
Other enrollees could be exempted if they are pregnant, receiving substance abuse treatment or too sick to work, but they would need to visit a health care provider to get the exemption.
Those who are working, looking for work, in school or a training program, or doing community volunteer work for at least 80 hours a month would be allowed to keep their health care coverage.
But the proposed law, which would take effect in 2020, says they must report monthly to county caseworkers. Failure to report would mean termination from the Medicaid program.
Counties aren't on board
Several counties testified that the bill would result in another unfunded mandate that could increase property taxes or cuts to other county programs. St. Louis County estimates it would require 30 new workers at a cost of $2 million. Hennepin County estimates it would need 250 additional workers at a cost of at least $17 million.
Representatives from This is Medicaid, a coalition of 116 organizations, were among the many who testified at both committee hearings this week. They raised concerns about cancer patients, those born with fetal alcohol syndrome, people with mental illness, people with disabilities who do not have a disability certification, people who are homeless, and many others who would be at risk for losing health coverage if they didn't fit into one of the exemption categories or were too sick to adhere to the monthly reporting requirements.
Willie Riley, a military veteran who is on Medicaid, told both committees that it has helped him keep working by giving him needed care.
"I returned [from the military] with a work ethic, and I work or tried to work all of my life," he said.
None of the jobs provided health benefits, he said, adding that without Medicaid, he would not have gotten help with post-traumatic stress disorder, manic depression, anxiety and a back problem.
"The loss of all this because I don't work one month would be devastation," he said. "Just the thought of it causes me worry.
"Putting more stipulations on us is not helping us, it is just making things worse," said Riley. "I was willing to protect my country; now I ask you to protect me."