Michigan: Gov. Snyder craps all over one of the few decent things he's done as Governor on his way out the door

Welp. There you have it. Via Jonathan Oosting of the Detroit News:

Snyder signs 80-hour Medicaid work requirement law

Most adult Medicaid recipients who receive health care insurance through the state’s Healthy Michigan plan will be required to work at least 80 hours per month or risk losing coverage under a new law signed Friday by Republican Gov. Rick Snyder.

Five years after he led the push to expand Medicaid eligibility under the federal Affordable Care Act, Snyder signed the new work requirements over protests from Democrats and advocacy groups who decried it as a legislative effort to strip health insurance from low-income residents.

...“The original estimates were that 400,000 people without health care would be able to obtain it after the creation of Healthy Michigan, and today more than 670,000 people have coverage. I am committed to ensuring the program stays in place and that Michiganders continue to live healthier lives because of it.”

...except for tens of thousands of enrollees who aren't able to comply with the convoluted reporting requirements, or who are medically frail but unable to "prove" it due to the official definition being unreasonably stringent, or any number of other reasons.

President Donald Trump’s administration opened the door to Medicaid work requirements last year. Michigan will need federal approval to implement the new work requirements, and critics have warned the law includes a trigger to end the Healthy Michigan program if the federal government does not grant the state a waiver.

Yup. If CMS fails to approve the waiver for whatever reason, the entire program will be at risk...

Not only that, the new bill puts Michigan’s entire Medicaid expansion under the Affordable Care Act (ACA) — covering 670,000 people — at risk. That’s because Michigan would be required to end its expansion if the federal Centers for Medicare & Medicaid Services (CMS) doesn’t approve an additional waiver that raises premiums on some Medicaid beneficiaries.

...which I guess is supposed to make this seem like good news:

Snyder said he met with officials at the Center for Medicare and Medicaid Services earlier this year and expects federal approval. Without it, his office said, the program would still continue through at least Feb. 1, 2020.

...Disabled residents, pregnant women, full-time students, children and one parent in a household with a child under the age of 6 would be exempt from the work requirements.

Yes, that's right: If you're a single parent scrambling to work enough hours to meet the minimum requirement, your 7-year old had better be really mature for their age.

The new work rules would apply to an estimated 540,000 able-bodied adults, according to the nonpartisan House Fiscal Agency, which projects about 5 to 10 percent of recipients would drop out or leave the program.

Translation: They estimate that 27,000 - 54,000 people will be kicked off of their healthcare coverage.

The law also seeks to tighten a four-year coverage limit for Healthy Michigan recipients, who would need to pay a 5 percent premium and complete healthy behaviors to stay on the plan.

Fun fact: People earning 100-138% of the Federal Poverty Line only have to pay around 2% of their household income for private ACA exchange policies in non-expansion states for a Silver plan with CSR assistance. On the other hand, that would only cover 94% of their medical expenses, while Medicaid covers about 99%, so I suppose that might be a wash.

Health care groups including the American Heart Association, American Lung Association and Cancer Action Network had called on Snyder to veto the bill.

But what would they know about it?

Signing the bill will jeopardize “healthcare coverage for 670,000 Michiganders, including those living with serious and chronic health conditions,” the coalition said earlier this month.

“Administering these requirements will not help low-income families improve their circumstances but will lead them to battling administrative red tape to keep coverage. With no way to circumvent this penalty, patients could face serious — even life or death — consequences.”

I always thought Republicans opposed creating expensive, complicated government bureaucracies? Ah, well...

An earlier version of the legislation would have required all adult and able-bodied Medicaid recipients to work at least 29 hours a week. It also included an exemption for rural counties that critics called racist but was stripped from the bill before it was sent to Snyder earlier this month.

Yup. The "good" news is that the racist exemption for rural white people was stripped out, and the work requirement was knocked down from 29 hours/week to 20, so I suppose you could argue that it's now 31% Less Cruel and Racism-Free®! So, there's that, I suppose.

As a refresher, here's why the final version of the law still stinks:

Up to 54,000 Michiganders would lose their Medicaid coverage under the revised bill, the Michigan House Fiscal Agency estimates. And that estimate is likely too low. It excludes coverage losses among people subject to higher premiums as a result of the bill, and it apparently assumes that everyone who’s eligible for an exemption from work requirements will secure one when, in reality, many people will likely be stymied by red tape and paperwork.

Those at particular risk of losing coverage include:

  • Working beneficiaries with unstable jobs. The industries that commonly employ Medicaid beneficiaries — such as health care, restaurant and food services, and construction — generally have variable hours, above-average levels of involuntary part-time work, and minimal flexibility. This makes it hard for many working people to get the required number of work hours each month to avoid losing coverage.
  • Older Michiganders. The work requirement would apply to adults up to age 62 unless they qualified for other exemptions. Older adults face special obstacles to meeting work requirements. In particular, people over age 50 are likelier to have a chronic health condition that makes it hard to maintain steady, full-time employment.
  • People with disabilities and other vulnerable groups. The work requirements in the revised Michigan bill, like proposals in other states, exempt people who are medically frail or have medical conditions that prevent them from working. Still, some people with disabilities and serious illnesses would inevitably fall through the cracks and lose coverage. This could occur because they don’t meet the criteria for limited exemptions, don’t understand that they qualify for an exemption, or struggle to provide the documentation to prove that they qualify.
  • People with incomes above the poverty line. As noted above, the bill would dramatically raise premiums on people above the poverty line. Premiums prevent many low-income people from maintaining coverage, research shows. Roughly 35,000 people would face these higher premiums, the House Fiscal Agency notes, and would be in danger of losing their coverage.

...These coverage losses will set back Michigan’s progress in improving access to care and health. In addition, the revised bill would lead to:

  • New state administrative costs. Michigan would spend $10 million a year to administer the work requirement, the state’s House Fiscal Agency estimates, in addition to up-front costs for new technology.
  • Higher uncompensated care costs. Michigan hospitals saw a 57 percent drop in uncompensated care costs as a share of their budgets as the state’s Medicaid expansion took effect, a recent report found. A work requirement leading to large coverage losses could reverse a large share of that progress.