Eager to work, but left behind if Medicaid adds job mandate
JACKSONVILLE, Ark. — On a frigid morning here, Nancy Godinez was piling bread and other staples into her car outside a food pantry. She had lost her job as a custodian, her unemployment checks had run out, and her job search had proved fruitless.
One thing she still had was health insurance, acquired three years ago after Arkansas’ Republicancontrolled Legislature agreed to expand Medicaid under the Affordable Care Act. The coverage, she said, has allowed her to get regular checkups and treatment for tendinitis in her foot.
But unless she finds a job, Godinez, 55, could be at risk of losing her insurance.
Gov. Asa Hutchinson is among a number of Republican governors hoping to impose a work requirement on Medicaid recipients. They believe extending Medicaid to millions of lowincome adults without disabilities under the health law gave them an incentive not to work.
Since its creation as part of President Lyndon Johnson’s Great Society agenda in the 1960s, Medicaid has grown to become a robust safety net program for poor Americans, providing health care for 74 million people. The new Republican ideas for the program, including work requirements and changes in how it is paid for, could make Medicaid much more limited, with a smaller impact on the federal budget but more obstacles to enrollment.
The outline of a new replacement plan, presented to House members Feb. 16, shows just how far some Republican leaders hope to go in overhauling a program that has grown under the Affordable Care Act to insure one in five Americans, including more than half of the roughly 20 million people who have gained coverage under the health law.
It would give each state a fixed amount of money for each Medicaid beneficiary, instead of paying a large share of whatever it costs to cover everyone who qualifies. And it would substantially reduce the amount the federal government pays to help cover the Medicaid expansion in Arkansas and 30 other states, a change that would most likely result in many people losing coverage.
In return, states would get far more freedom to structure their Medicaid programs as they wished. Now, even as divisions among Republicans in Congress slow efforts to repeal the Affordable Care Act, Hutchinson and
“Middle-class America believes in work because we do it ourselves. But we have resources, an education, transportation, a supportive family.”
– MANDY DAVIS, SOCIAL WORKER IN LITTLE ROCK
other Republican governors are developing proposals to require many Medicaid recipients to have a job, participate in job training or perform community service.
“It gives dignity; it gives responsibility,” Hutchinson said.
Work requirements have long been central to the Republican goal of instilling a sense of “personal responsibility” in people who benefit from government programs. But it was an Arkansas Democrat, Bill Clinton, whose embrace of work requirements for welfare recipients when he was governor became the basis for the 1996 federal welfare law enacted during his presidency.
In fact, 59 percent of nondisabled adults on Medicaid do have jobs, according to the Kaiser Family Foundation. But advocates for the poor say low-income people often face numerous roadblocks in finding work. Some have criminal records. Others lack a cellphone or reliable transportation, said Mandy Davis, a social worker at Jericho Way, a resource center for the homeless in Little Rock.
“Middle-class America believes in work because we do it ourselves,” Davis said. “But we have resources, an education, transportation, a supportive family.”
It was Hutchinson’s Democratic predecessor, Mike Beebe, who got the state’s Republican-controlled legislature to expand Medicaid by using federal funds to buy private insurance for the poor. Hutchinson said in the interview he wanted to continue the expansion here, but if the federal government stopped paying most of the cost as the health law requires, “we’ll just have to look at it again.”
He said he would either seek the Trump administration’s permission to impose a work requirement or seek a block grant — and, with it, leeway to create new rules — to cover those who newly qualified for Medicaid under the health law.