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Medicaid's Future

Trump Administration Decides That The Key To Making You Healthier Is Taking Away Your Medicaid

The Trump administration announced on Thursday that it will support work requirements for Medicaid beneficiaries for the first time in the program’s history. Its justification: cutting insurance for low-income Americans who don’t work will improve their health.

The logic of this argument falls apart when one reviews the entire body of medical research and the history of Medicaid over the past few decades.

According to the Kaiser Foundation: Some states and the Trump administration have stated that the ACA Medicaid expansion targets “able-bodied” adults and seek to make Medicaid eligibility contingent on work. Under current law, states cannot impose a work requirement as a condition of Medicaid eligibility, but some states are seeking waiver authority to do so. These types of waiver requests were denied by the Obama administration, but the Trump administration has indicated a willingness to approve such waivers. This issue brief provides data on the work status of the nearly 25 million non-elderly adults without SSI enrolled in Medicaid (referred to as “Medicaid adults” throughout this brief) to understand the potential implications of work requirement proposals in Medicaid. Key takeaways include the following:

  • Among Medicaid adults (including parents and childless adults — the group targeted by the Medicaid expansion), nearly 8 in 10 live in working families, and a majority are working themselves. Nearly half of working Medicaid enrollees are employed by small firms, and many work in industries with low employer-sponsored insurance offer rates.
  • Among the adult Medicaid enrollees who were not working, most report major impediments to their ability to work including illness or disability or care-giving responsibilities.
  • While proponents of work requirements say such provisions aim to promote work for those who are not working, these policies could have negative implications on many who are working or exempt from the requirements. For example, coverage for working or exempt enrollees may be at risk if enrollees face administrative obstacles in verifying their work status or documenting an exemption.
  • Among nonelderly adults with Medicaid coverage—the group of enrollees most likely to be in the workforce—nearly 8 in 10 live in working families, and a majority are working themselves.
  • Most Medicaid enrollees who work are working full-time for the full year, but their annual incomes are still low enough to qualify for Medicaid.
  • Many Medicaid enrollees working part-time face impediments to finding full-time work.
  • Nearly half of working adult Medicaid enrollees are employed by small firms, and many work in industries with low employer-sponsored coverage offer rates.
  • Among the adult Medicaid enrollees who were not working, most report major impediments to their ability to work.

Policy Implications

  • Under current law, states cannot impose a work requirement as a condition of Medicaid eligibility.
  • Some states have proposed tying Medicaid eligibility to work requirements using waiver authority that may be approved by the Trump Administration.
  • Research shows that Medicaid expansion has not negatively affected labor market participation, and some research indicates that Medicaid coverage supports work.

This approach, which is clearly targeted at those lazy people who live off the public dole and contribute nothing to society, as viewed by conservatives, is not only misdirected, it is a cruel hoax that will have repercussions for those people in need and for our country's future.

"It was once said that the moral test of government is how that government treats those who are in the dawn of life, the children; those who are in the twilight of life, the elderly; and those who are in the shadows of life, the sick, the needy and the handicapped."

~ Hubert H. Humphrey

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