MICHIGAN: RED ALERT: Medicaid Work Requirement being voted on THIS WEEK! Call your legislator NOW.

2018 MIDTERM ELECTION

Time: D H M S

As I noted last month, the Republican-controlled Michigan State Senate is planning on jumping on board the pointless, wasteful, cruel "work requirement" bandwagon which is all the rage among the GOP types these days.

Sure enough, they're planning on ramming it through within the next week: The Michigan Senate’s Competitiveness Committee is expected to hold a hearing on SB 897, a bill that would impose a work requirement on over 670,000 adult Michiganders with Medicaid health coverage...or nearly 7% of the state population.

The committee chair and the bill’s sponsor, Senator Mike Shirkey (SD-16) is planning on pushing the committee vote through ASAP and then kicking it over to the full state Senate right away.

The silver lining here is that, as I noted last week, MI Gov. Rick Snyder may come out in opposition to the bill. He felt pretty strongly about passing "Healthy Michigan" (our name for ACA Medicaid expansion) in the first place and has been rightly proud of it ever since. If it passes the state Senate and House, he might even veto it...but then again, he might not, so it's vital to try and stop it from passing in the first place.

Under SB 897, enrollees would lose Medicaid coverage if they did not work or participate in qualifying work activities for 29 hours each week. Other states imposing similar requirements are projecting large coverage losses. For example, Kentucky projects that its Medicaid waiver will ultimately lead 15 percent of adult enrollees to lose Medicaid coverage. In fact, that's the entire point...the state would "save money" by kicking people off their healthcare coverage.

Michigan’s proposal is actually harsher than Kentucky’s: It would requires 29 hours of work per week instead of 20, and wouldn't exclude parents.

As healthcare advocates have repeatedly pointed out, most Medicaid expansion enrollees already work...but under SB 897, they could still lose their coverage if they fall below that 29 hour threshold or had a gap between jobs. Even among those who don't have a paid position, the vast majority are students, caregivers for another family member, or have a disability which prevents them from working but may not meet the official diagnosis to allow an exception. Others have serious mental health issues.

The University of Michigan’s monitoring reports have consistently shown that the expansion has saved the state money, increased health coverage, and connected Michiganders with needed care. And a recent report found Michigan hospitals saw uncompensated care costs cut by more than half as expansion took effect. A work requirement leading to large coverage losses could reverse a large share of these gains.

The work requirement would also force the state to come up with millions of new dollars to create, implement, and administer the program:

The bill's sponsor, Sen. Mike Shirkey, R-Clark Lake, says this isn't about money. A state Senate Fiscal Agency analysis estimates it would cost $20 million to $30 million to implement and administer, and that any savings would likely be "slight." 

Any sort of work requirement would increase state costs, cut people off their coverage, and threaten the progress Michigan has made in covering its low-income residents in recent years.

The coalition work is being coordinated by the Michigan League for Public Policy. Please visit the Action Network website to contact your state Senator and Representative to urge them to vote NO on work requirements for Medicaid. The Moms Rising website also has helpful action items.

ONCE AGAIN, as I wrote back in 2015:

...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 Joan McCarter over at dKos:

Most of these people are already working...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 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%--at most--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.

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