Michigan: Surprising absolutely no one, "God's Safety Net" law will result in up to 183,000 losing Medicaid coverage


Light posting for the next two weeks as I'm dealing with my kid's upcoming bar mitzvah and some other personal stuff, but this one literally hits home.

You may recall that last spring, Republicans in the Michigan legislature attempted to push through a bill to change the state's current ACA Medicaid expansion program (which is close to "vanilla" Medicaid with a few minor tweaks) by tacking on pointless, ineffective and (in an earlier draft) blatantly racist work requirement provisions:

White, Rural GOP Counties Get Exempted from Medicaid Legislation

Republicans in the legislature are working to change Medicaid in Michigan, but only for certain people, as they have tailored the language of pending legislation to exempt some of their constituents from being affected.

...Perhaps conveniently, the counties benefitting from that exemption are mostly rural, mostly white and predominately represented by Republicans, including a bill co-sponsor. And because the exemption is based on the county rather than a city, village or township, for example, those living in urban centers with high unemployment rates don’t get to benefit from the exemption.

While the Free Press pointed out Detroit was one of those cities, information from Michigan agency tracking unemployment rates showed that in March, other predominately Black communities like the cities of Muskegon, Saginaw, Flint, and Highland Park also had unemployment during the month of March – the most recent month for which data is available – exceeding the 8.5 percent threshold in the pending legislation.

This caused quite an uproar, to the point that they removed that particularly ugly portion, while also knocking the hour requirement down from 29 to 20 hours per week, leaving the bill...not quite as terrible, but still pretty terrible:

LANSING, Mich. (AP) — The sponsor of proposed Medicaid work requirements said Monday that lawmakers are removing a provision to exempt recipients who live in Michigan counties with high unemployment, saying it would have been too difficult to administer and denying allegations of racism.

Republican Sen. Mike Shirkey of Clarklake also told The Associated Press that the proposed 29-hour-a week workforce engagement requirement for able-bodied adults is being lowered to “very close” to 20 weeks. That is in line with the three states that have enacted Medicaid work laws and with Michigan’s work requirement for food assistance beneficiaries.

After that, the bill was quickly passed along party lines and signed by Republican then-Governor Rick Snyder, even though dozens of healthcare/patient advocacy organizations had repeatedly warned that this would cause tens of thousands to lose their healthcare coverage...in many cases whether they complied with the work requirements or not:

  • Harm working Medicaid beneficiaries. The industries that commonly employ Medicaid beneficiaries — such as health care services, restaurant and food services, and construction — generally feature variable hours, above-average levels of involuntary part-time work and irregular scheduling, and minimal flexibility....
  • Harm people with disabilities and other vulnerable groups. The Michigan bill, like proposals in other states, exempts 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....

But have no fear, said state Senator and sponsor Mike Shirkey! GOD WILL PROVIDE!

...Sponsoring Sen. Mike Shirkey, R-Clarklake, created exemptions in the Michigan legislation that would waive the work requirement for parents with young children, pregnant women or caretakers for disabled family members. But asked about people like Maitre who could still lose health care, he told reporters the social safety net “by definition, has a lot of holes in it.”

“The best safety net ever invented by God is family,” Shirkey said, “but I’m not sure that government is supposed to supplement that process.”

...which means that if you don't happen to have any family members nearby to help out, it's because God hates you, I guess. Plus, while I agree that the support of a loving family is a great thing, a hug from your sister doesn't do much good if you need dialysis or a hip replacement.

Anyway, it all fell on deaf ears.

Yeah, well, guess what?

New work requirements for people in Michigan's Medicaid expansion group could cause as many as 183,000 people to lose their coverage.

Anywhere between 9 and 27 percent of the approximately 680,000 people enrolled in the Michigan Healthy Plan - or 61,000 to 183,000 recipients - could be kicked of the rolls.

That's up to three times what was estimated by the House Fiscal Agency when the work requirement bill was passed last year. The work requirements are scheduled to take effect on January 1, 2020.

These findings are from a recent study by Manatt Health, a national consulting firm and division of the legal and consulting firm of Manatt, Phelps and Phillips.

The silver lining, of course, is that Rick Snyder is no longer Governor; Gretchen Whitmer is, and she's not having this:

Democratic Gov. Gretchen Whitmer said Friday that she will ask the Republican-led Legislature to change newly enacted work or job-related requirements to qualify for Michigan’s Medicaid expansion program, saying that between 61,000 and 183,000 residents could lose coverage should the rules take effect in 2020, as scheduled.

...“As governor, I am committed to doing everything in my power to defend Healthy Michigan and protect coverage for the 680,000 Michiganders who rely on it for quality care,” Whitmer said in a statement. “That’s why I plan to take steps in the coming weeks to work with our partners in the Legislature to change the Healthy Michigan Plan so that it preserves coverage, promotes work, reduces red tape and minimizes administrative costs.”

Messages seeking comment were left with GOP legislative leaders, who likely will resist changing work rules that became law in June.

...At the time Michigan’s law was enacted, Whitmer wrote, its effects were “speculation” because work rules in other states had not taken effect. She said in Arkansas, 18,000 people lost their insurance in the first seven months – “and Michigan’s statute is more sweeping … threatening a broader range of adults with more exacting reporting demands.”

Unfortunately, while Michigan elected a Democratic Governor and increased the number of Democrats in both the state House and Senate, neither chamber actually flipped control, so both remain in GOP hands for another two years, and...

...Republican lawmakers have defended the law, saying it will help fill job openings.

This, of course, is a load of hot garbage. I said so at the time, and this story by Noam Levey in the L.A. Times from last week proves it:

As it races to revamp Medicaid by allowing work requirements for the first time, the Trump administration is failing to enforce federal rules directing states to assess the impact of the change on low-income patients who rely on the half-century-old safety net program, a Times analysis shows.

None of the eight states that the administration has cleared to implement a Medicaid work requirement has in place a plan to track whether Medicaid enrollees find jobs or improve their health, two goals often touted by administration health officials.

And nine of the 17 states that have sought federal permission to implement Medicaid work mandates have been allowed by the Trump administration to proceed with their applications despite failing to calculate the number of people who could lose coverage, according to a review of state and federal Medicaid records.

...Critics say the administration and the states appear to be systematically ignoring or weakening the requirement for independent analysis, perhaps because they fear the results.

“There is a lot of hiding the ball here,” said Joan Alker, executive director of the Georgetown University Center for Children and Families, a research organization that is tracking the administration’s efforts to revamp Medicaid rules.

...However, state officials seeking permission to implement work mandates in Arizona, Arkansas, Kansas, Michigan, New Hampshire, Oklahoma, South Dakota, Tennessee and Wisconsin did not project in any detail how their experiments would affect Medicaid enrollees’ coverage, according to a review of hundreds of pages of state documents filed with the federal Center for Medicare and Medicaid Services, or CMS.

...Nevertheless, the Trump administration deemed all the state Medicaid applications “complete,” CMS documents show.

In other words, it was never about "the dignity of work" or "empowering people to raise themselves up", yadda yadda yadda. It was purely about 1) saving the state money (you know, very thing Shirkey claimed it wasn't about) and 2) humiliating people by making them grovel before the government to avoid dying or suffering from a debilitating illness.

Which is pretty much what I was saying nearly four years ago.

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."