Work is best medicine for unsustainable Medicaid

The statistics are staggering and make one thing clear: Medicaid in New Mexico is on an unsustainable path. Consider:

About 43 percent of New Mexico’s population — more than 700,000 people — is on Medicaid.

About 77 percent of the babies born in the state are Medicaid babies.

The federal government covers much of the cost with matching funds, but the state’s share alone will climb to almost $1 billion this year if the Legislature accepts the budget recommendation of Gov. Susana Martinez to add another $38 million to the Medicaid budget. That state share number will balloon in future years as costs of health care go up and the federal government share of Medicaid expansion goes down.

Meanwhile, businesses all over Albuquerque are sporting window signs that say things like, “Hiring with good benefits and flexible hours.” The claim that there are no jobs out there is nonsense.

Those are just some of the reasons New Mexico should join nine other states in moving to implement work requirements for able-bodied, adult Medicaid recipients. There are plenty of other good reasons. First, the requirements aren’t onerous — unless you accept the proposition that people who simply choose not to work are entitled to a free ride courtesy of the rest of us. In general, recipients who fit into this category would have to work or volunteer at least 20 hours a week, or be enrolled in school or job training in order to keep their benefits.

Indeed, many of the “working poor” already meet them. And under the ACLU definition in its challenge to Albuquerque’s intersection panhandling ordinance, even some of those folks on the corner would meet it — assuming they are documenting their “work” and filing tax returns.

The state of Kentucky estimates it would reduce its Medicaid rolls by more than 80,000 and save about $300 million over five years. That’s money that can go to things like public education, public safety and taking care of the severely disabled.

The unfortunate, unintended consequence of the current policy is that it discourages people from having a job — or at least one where their income is reported because they face losing the benefit.

And what a benefit it is. Medicaid is a Cadillac health plan that far outstrips anything working folk have in the health insurance they pay for. No copays, no penalties, free rides to the doctor, name brand drugs, etc.

Those working folks face ever higher deductibles, copays and premiums because the government doesn’t cover the actual cost of those Cadillac Medicaid services incurred at doctor offices and hospitals. That means some of those costs end up getting passed on to people with private health insurance. The work/school/volunteer requirement is far better social policy than incentivizing poverty and spending the day playing video games. It may be a quaint notion, but there is a benefit to work and responsibility.

Of course there are arguments against. Critics of the work requirement basically oppose making people do anything for what is now free stuff, but also say government is incapable of administering the program well. Indeed, government bureaucracy is hardly a template for efficiency, but the incompetence defense should not prevail over budget and social policy. And the requirement is predicated on the presumption those who can work, will work, to keep their Medicaid coverage rather than clogging ERs.

States as varied as Arizona, Maine, Utah and Wisconsin have submitted proposals to include a work requirement. New Mexico should join them.