The March 30 editorial counterpoint by state Sen. Mark Johnson and state Rep. Kelly Fenton about their proposed Medical Assistance (MA) work requirements (“It’s only fair: Work requirements are reasonable in exchange for free health care”) curiously omitted crucial facts about their bill and grossly misrepresented the bill’s projected fiscal impact.
First, most adult, nondisabled MA beneficiaries already work. Yet they will be required under the bill to document, every month, that they are in fact complying with the bill’s requirements. It bears noting that adult, nondisabled adults who qualify for one of the bill’s exceptions will also have to document the existence of their exception. The “hassle factor” involved in meeting this requirement monthly, without fail, is a major reason otherwise-qualifying SNAP (Supplemental Nutrition Assistance Program) and TANF (Temporary Assistance for Needy Families) recipients fall off the rolls. It would likely have the same effect here.
Second, the bill wouldn’t save the state a dime. In fact, it would lose money. The related fiscal note — an in-depth analysis of proposed legislation’s projected costs and other financial impacts — states that not only will Minnesota have to spend almost $7 million extra because of changes that the bill would cause, but it would also lose more than $110 million in federal money that the state currently gets to pay for health care for MA beneficiaries. Counties would likely be out even more.
Third, the bill appropriates not one penny toward helping MA beneficiaries who aren’t working to find and keep jobs. Not one penny goes toward funding the additional people who will seek job training or need transportation. Not one penny goes toward funding state and county employees to assist with job-search efforts. In fact, the deputy commissioner of the Minnesota Department of Employment and Economic Development testified that the bill would likely double the number of people his department would need to serve, not necessarily to help with job searches, but rather to provide documentation for the bean counters the counties and state will need to employ to keep track of each MA beneficiary’s work, education or job-search efforts.
Fourth and finally, many of those bean counters will be new government employees. Johnson and Fenton say they don’t understand why the state would need to hire more workers as a result of the bill, as the requirements are similar to those under SNAP. Yet the bill’s fiscal note clearly says the state will need at least 65.5 new full-time-equivalent employees by 2021 to push paper and especially to handle the call-center volume that will be increased by having to serve many thousands of additional people.
If the bill will cause thousands of Minnesotans to lose health coverage, add millions to state and county expenditures, cause the state to lose more than $110 million in federal health care funding, and help not one person to get a job, why on earth are the Republicans backing this bill? If they just want to save the state money, then they should repeal the Medicaid expansion outright or stop funding nursing home care for middle-class seniors — but they know neither would play well with voters. If they want to help people get and keep jobs, then they wouldn’t cut people’s health care — the very thing that allows people with chronic health conditions like diabetes and mental health problems to stay healthy enough to work.
My best guess, given the foregoing and given similar efforts in states like Kentucky, Indiana, Arkansas and others, is that they’re trying to make people believe MA is a welfare program, like cash welfare and food stamps. But it’s not. MA is a work-support program when used by nondisabled adults, and that’s the way most nondisabled adults already use it.
Do we really want to bloat government bureaucracy and spending, take away people’s health care so they can’t stay healthy enough to work, and not offer even a dime in additional funding for job search and training for those who need it? This is what Johnson and Fenton’s bill would do. We need to do better.
Laura Hermer is a professor of law at the Mitchell Hamline School of Law.