The Adults (and Patients?) a Medicaid Work Requirement Would Leave Behind

I recently read an article from The New York Times regarding some of the conversations that are happening now about the future of Medicaid and in particular, the work requirement(s) that many GOP legislators want to impose: "The Adults a Medicaid Work Requirement Would Leave Behind."And without exaggeration, Medicaid has been saving my life.

Medicaid has been saving my life

The article caught my attention because for the first time in my life, since August 2016, I've been receiving Medicaid benefits--as a supplemental insurance to my very expensive HMO policy.

And without exaggeration, Medicaid has been saving my life. I wasn't even that sure of what it was or how it worked all of the years of my young adult life because it didn't affect me personally, and I couldn't qualify for it most of those years (until the expansion under Obamacare/ACA).

But now, during the brief six months of being on Medicaid (or Medical Assistance, as it's called in Minnesota), I can see how much it helps people.

A brief history on Medicaid

Since Medicaid's creation in the 1960s under President Lyndon Johnson, the program has grown to become a "robust safety net for poor Americans, providing health care for 74 million people," according to the NYT article.

Despite this impressive number, there are still many people who don't know or understand much about it, I'd argue. Nor do they realize the huge impact imposing restrictions and decreasing funding would have on the lives of so many Americans.

What is Medicaid?

The official website for Medicaid explains a bit more about the program:

Authorized by Title XIX of the Social Security Act, Medicaid was signed into law in 1965 alongside Medicare. All states, the District of Columbia, and the U.S. territories have Medicaid programs designed to provide health coverage for low-income people. Although the Federal government establishes certain parameters for all states to follow, each state administers their Medicaid program differently, resulting in variations in Medicaid coverage across the country.

Beginning in 2014, the Affordable Care Act (ACA) provides states the authority to expand Medicaid eligibility to individuals under age 65 in families with incomes below 133 percent of the Federal Poverty Level (FPL) and standardizes the rules for determining eligibility and providing benefits through Medicaid, CHIP and the health insurance Marketplace.

How does the Affordable Care Act relate to Medicaid?

In addition to wanting to completely repeal the ACA right now, Republicans are eager to make significant changes to Medicaid, including how it's paid for as well as imposing work requirements for non-disabled applicants and enrollees.

Republican leaders and legislators are developing proposals that would require Medicaid recipients to have a job, participate in job training, or perform community service. Many Republicans justify the need for a work requirement due to the belief that extending Medicaid to millions of low-income adults without disabilities under the ACA gave people an incentive not to work.

I'm on Medicaid and I currently work

Reading this line in the article about people on Medicaid not wanting to work immediately infuriated and disgusted me.

While of course, this could be true in some situations, I doubt that the majority of people receiving Medicaid assistance don't want to work. I'm on Medicaid and I currently work two part-time jobs (sometimes three) while living with a painful chronic illness. I also don't qualify as being officially "disabled," and therefore receive no disability benefits. I definitely work, but it's not always steady or consistent.

The accusation of leeching off of the system is insulting

Right now I need help affording my healthcare, but that doesn't mean I don't want to work. On the contrary, I want to be able to work and live my life as a "normal," productive, and contributing member of society.

Honestly, who wouldn't want that? Am I naive to think that many do? The insinuation (or accusation) that people are unmotivated, lazy, or are leeching off "the system," feels quite insulting.

According to the NYT article and the Kaiser Family Foundation, 59 percent of non-disabled adults on Medicaid do have jobs. But for those who don't, advocates for the poor say low-income people often face numerous roadblocks in finding work. Some have criminal records, or lack a cell phone or reliable transportation. Others have significant health issues that prevent them from steady work yet they can't qualify for disability benefits.

Work requirements for Medicaid

In the NYT article, Leonardo Cuello, director of health policy for the National Health Law Program in Washington, argues against imposed work requirements for Medicaid recipients:

Applying work requirements to health coverage gets it exactly backward. An individual needs to be healthy to work, and a work requirement may prevent them from getting the health care they need in order to be able to work.

How would this work for people with chronic health conditions?

Cuello also said it would be difficult for states to determine which of their Medicaid enrollees were truly capable of work. As in the cases of patients with chronic illnesses and chronic pain, for example, some people may be legitimately disabled but not approved for disability benefits. If they physically can't work due to illness/injury/etc., and can't receive any disability assistance, how are they supposed to pay for healthcare? This is what worries me.

Many Americans won't have health coverage

While I do not believe that people should take advantage of government assistance programs (and I know that people do), I do strongly believe that there are a lot of Americans who will fall through the cracks and be denied crucial health coverage if these new Medicaid proposals become law.

I finally feel hopeful about my own life-improving and like I'm able to start climbing out of the deep, dark abyss of medical debt that I've been struggling in for over a decade. But now, with these possible impending changes, I'm terrified that I'll soon be thrown back into the pit.

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