END OF 2018 OPEN ENROLLMENT PERIOD (42 states)

Time: D H M S

GOP Govs to Medicaid expansion enrollees: DANCE, SPIDER, DANCE!!

There's not one, not two, not three but four articles I'm reading this morning centering around the same theme: GOP governors who are finally starting to at least consider expanding Medicaid under the Affordable Care Act, but only if the enrollees jump through various hoops in order to qualify:

Sarah Wheaton, Politico:

In nearly a dozen Republican-dominated states, either the governor or conservative legislators are seeking to add work requirements to Obamacare Medicaid expansion, much like an earlier generation pushed for welfare to work.

The move presents a politically acceptable way for conservative states to accept the billions of federal dollars available under Obamacare, bringing health care coverage to millions of low-income people. But to the Obama administration, a work requirement is a non-starter, an unacceptable ideological shift in the 50-year-old Medicaid program and a break with the Affordable Care Act’s mission of expanding health care coverage to all Americans. The Health and Human Services Department has rejected all requests by states to tie Medicaid to work.

Greg Sargent, Washington Post:

Politico reports this morning that there is a real shift underway among red state governors towards Obamacare: A number of them are newly open to accepting the Medicaid expansion — as long as they can couple it with some kind of work requirement.

This might seem like just more “safety-net-as-hammock” talk from Republicans — i.e., government assistance for poor people will sap their work ethic, so the only way red states can accept Obamacare money to expand health coverage to them is with some kind of work provision so they don’t get lulled into dependency while lounging in that hammock.

But I’m going to suggest that this is, on balance, a good development — in the sense that more GOP governors appear open to finding terms upon which they are willing to take the money to cover their constituents.

Lisa Baumann, Associated Press:

Buttrey calls the plan the most conservative in the nation due to the copays, premiums and other provisions. Because of those items, the state must seek a waiver from the federal government to put the program in place.

Bullock said his staff will draft the plan and allow Montanans to comment on it before submitting it to the federal government. Once they receive it, Bullock said the waiver process could take from three to six months although there's no required timeline for approval.

"We're pushing government further than any state has," Buttrey said.

Buttrey estimates that if it is approved, only about 45,000 people of the 70,000 eligible will sign up for Medicaid in the next four years at least in part due to the copay and premium requirements.

I do see Sargent's point here; the fact that Republican governors are open to embracing (well, "grudgingly accepting", anyway) any part of Obamacare is in and of itself a positive sign of how the sand is shifting beneath their feet. Even so, aside from the fact that adding all of these extra requirements (ironically the same sort of "bureaucratic red tape" which conservatives supposedly hate) tends to overcomplicate what is historically an extremely efficient program (according to the Kaiser Family Foundation, Medicaid's administrative costs are only 7%, about half the rate of private insurance), there's another, uglier issue which is addressed by McCarter over at dKos:

Joan McCarter, Daily Kos:

Most of these people are already working, assholes. How about instead of trying to embarrass them further for being poor, you work on embarrassing their employers for refusing to provide them health insurance or refusing to pay enough that they can buy it with Obamacare subsidies? And why isn't the fact that most people who would qualify for Medicaid who are now in the gap are working the beginning point in any discussion about Medicaid expansion and work requirements?

To Politico's credit, they do report (about 15 paragraphs in) that the majority of these people work, and add that among "those who don’t work, about a third said they were taking care of a home or family member, 20 percent were looking for work, and 17 percent were mentally ill or disabled." They point out that those numbers are close to the national labor force participation rate. There's a reason why this population is called the "working poor." Because they are working!

The graph accompanying the KFF report states that 43% of those still in the Medicaid Gap (about 3.8 million total) work full time and 23% are working part-time, or 66% of the total (the Politico article cites 57% from a March 2014 survey...but that one applied to the full 14.4 million people who could potentially enroll in Medicaid if every state expanded the program).

In other words, ironically, a higher percentage of poor people in non-expansion states are already working than in the states which have already expanded Medicaid.

In any event, that leaves 34%. 1/3 of that is around 11% of the total, 1/5 of it is about 7%, and 17% = around 6%.

In other words, only about 10% of those still in the Medicaid Gap appear to match the GOP's cliche of a "lazy, good-for-nothing layabout" type who's able-bodied, has no serious extenuating circumstances and so forth. The "get off your ass and work!" requirements appear to be nearly as big a waste of time and resources as the infamous "drug testing for welfare recipients" bandwagon which a bunch of states jumped on board over the past few years.

As for the other requirements (co-pays/premiums), this is kind of the same sort of logic which recently led a GOP state Senator to come to the brilliant conclusion that slashing the Medicaid budget in half would free up money for other stuff! Why yes, of course it would. Just as requiring people on Medicaid to pay a chunk of the cost of their treatment would, as demonstrated by the Montana example above, save money as well...because 36% of those eligible would never enroll in the program in the first place! BRILLIANT!!

For that matter, guess what else would "save money" for the state? Killing all of the people in the Medicaid Gap! Then you wouldn't have to deal with them at all!

Basically, Republicans have gone from saying "screw the poor" to "OK, you can see a doctor but only if you dance for me first."