Minnesotans, beware of health policy zombies in 2019. A dubious medical coverage “reform” that died during this year’s legislative session — Medicaid work requirements — shouldn’t be resurrected, though there will likely be misguided interest in doing so.
Evidence continues to mount that the proposed policy change would do the opposite of what proponents promise. Instead of saving money, these requirements would likely cost more to administer than they save. Nor do the requirements appear to boost workforce participation.
Those are key takeaways of new reports published this month by respected outlets — the National Bureau of Economic Research and a Journal of the American Medical Association (JAMA) publication. States such as Minnesota, which have weighed work requirements, and the 11 other states taking serious steps to impose them, should heed the red flags raised in these analyses.
Medicaid is a state- and federally-funded program providing medical care to 73.4 million poor, disabled and elderly Americans. Changes to eligibility require careful consideration to avoid cutting off access to a doctor or medications, particularly when loss of parental coverage can translate into reduced care access for their children.
It is not enough to simply have a gut feeling that a new policy will achieve what proponents seek. And yet that is essentially what is behind the Republican-led push in Minnesota and elsewhere to impose work requirements on some adult enrollees. Public policy should be guided instead by evidence and those with medical expertise.
While research is continuing on work requirements, what is available suggests that it does not achieve its aims. The main reasons: Many Medicaid enrollees are already working or would qualify for work requirement exemptions due to disability, chronic illness or other reasons. Also, the additional administrative burdens would be costly. In Minnesota, compliance would largely fall on counties. Hennepin County, for example, projected it would need to hire 30 staffers.
The new report published by the National Bureau of Economic Research evaluated the impact of a 2005 Tennessee decision to disenroll about 200,000 adult Medicaid enrollees. The move significantly increased the state’s uninsured rate and failed to boost employment, as a Center on Budget and Policy Priorities write-up highlighted.
Two other analyses were published online Sept. 10 by JAMA Internal Medicine. The overlapping conclusions: Savings would be minimal because so many Medicaid enrollees already have jobs and so few people would be subject to the new requirements. By one eye-opening estimate, those who would be subject to the requirements account for less than 1 percent of Medicaid spending. Real savings would instead come from eligible people losing coverage because they didn’t keep up on the paperwork. The trade-off: “substantial cost in terms of human health,’’ according to the authors.
A coalition of state public health advocates known as This is Medicaid waged a ferocious lobbying battle during the past session to fend off this disingenuous initiative in Minnesota. They shouldn’t have to repeat the effort.
The evidence suggests that work requirements add red tape and administrative costs and do little to put people back in the workforce. Data should guide lawmakers, not the desire to stoke politically self-serving anger at Medicaid enrollees. This ill-considered policy shouldn’t rise from the grave in 2019.
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