By Glynis hart
I used to live near a renowned state agricultural school and veterinary college (Cornell), where the following joke went around every few years: The story was that the college was doing an experiment on gradually reducing the amount of feed a horse received, by one piece of hay per day, to see if over time the horse could adapt to living on nothing. The experiment was going well (the joke went) but unfortunately it had to be discontinued because the horse died.
New Hampshire is conducting a similar experiment, only in this version the experiment is to see if taking away health care from the working poor will make them healthier.
New Hampshire accepted Medicaid expansion under the Affordable Care Act with waiver 1115, which allows the state to add certain requirements, such as making sure participants in the government health insurance program are working, or trying to. For New Hampshire residents, this means the people covered by the expansion (up to 138% of federal poverty level) must either work/volunteer/retrain for 100 hours a month, be taking care of an infirm relative/child, be pregnant or disabled.
The idea behind work requirements is to turn around a culture of dependency, teaching people to help themselves before asking others for help. Most Americans would agree this is generally a good idea — teach a man to fish, etc. etc.
However, a study done in Arkansas, one of the first three states to implement work requirements for Medicaid, found that while 17,000 people dropped out of Medicaid in the first three months of the work requirement, an equivalent 17,000 never showed up on employment rolls. If the plan was that taking these people’s Medicaid would cause them to get jobs (and thus gain access to better insurance), the study found no evidence it had done so.
Instead, the study found a rise in the percentage of uninsured from 10.5% to 14.5%.
An analysis of the study led by Benjamin Sommers, M.D., a professor of health policy and economics at the Harvard School of Public Health, found that over 90% of those affected by the Arkansas work requirement were already fulfilling it. They were already working, disabled, or taking care of someone else who couldn’t work.
The Harvard researchers contacted people to find out what happened. Two-thirds of the respondents didn’t know about the new requirements until their coverage disappeared; still others didn’t believe they would be eligible, so they didn’t apply. Still others found it impossible to fulfill the reporting requirements, whether because their literacy level got in the way or because they didn’t have internet access (Arkansas’ system was all online). In the end the added layer of paperwork formed a barrier to people accessing Medicaid, much more than the new rule itself.
U.S. District Judge James E. Boasberg ruled against and stopped Arkansas’ then Kentucky’s work requirements for Medicaid, then New Hampshire’s as well. Since the end of July, New Hampshire’s work requirement has been in legal limbo, as the Sununu administration appeals the federal ruling. Gov. Chris Sununu has expressed his “disappointment” with the ruling and said the state is implementing its work requirements “responsibly and in a manner that would ensure that no individual would inappropriately lose coverage.”
Indeed, before Boasberg’s ruling, the state was taking steps not to dump 17,000 people off the state’s Medicaid rolls. In June, after that number of Medicaid recipients failed to provide proof of exemption from the state’s work requirements, instead of abruptly dropping their coverage, the state Department of Health and Human Services implemented a three-month extension and mounted a door-to-door campaign to let people know about the new rules. That campaign is now in abeyance while the work requirement goes through the courts.
Sununu views the federal court ruling as a bump in the road and has said that, eventually, New Hampshire’s work requirements will be approved. The Trump administration is appealing the Arkansas and Kentucky rulings; eight states have had their work requirements for Medicaid recipients approved, and it seems likely that in New Hampshire Sununu will eventually get his wish.
It’s important to note that most people affected by the work requirement are the working poor: they have an income (otherwise they’d be eligible for Medicaid) or some other means of support (such as help from family members) that lifts them slightly above the poverty line. Many are in work-retraining programs or other programs of study (student loans and grants can count for income), work part-time, or work low-wage or seasonal jobs that don’t provide health insurance.
Working parents of Medicaid-eligible children are another large group, as Medicaid requirements for children and adults are different. Although the children in a family may be covered by Medicaid, a parent working enough to pass the income limit ($22,715 for a one parent, one child household), will not be.
In the Granite State, 50,000 people are insured through Medicaid expansion. If the governor really wants those people to get better jobs with health insurance, there are better ways to do so than by whittling away their medical care and seeing if they survive.