The Trump administration’s recent endorsement of work requirements in Medicaid and increased state flexibility is part of broader strategy to shrink the fast-growing program for the poor and advance conservative ideas that Republicans failed to get through Congress.
Seema Verma, administrator of the Centers for Medicare & Medicaid Services, laid out her vision for the state-federal program in two appearances last week, saying her new course give states wide latitude over eligibility and benefits.
In a speech Nov. 7 to state Medicaid directors, Verma said the program needs to give people “hope that they can achieve a better future for themselves and their families, hope that they can one day break the chains of generational poverty and no longer need public assistance.”
She has noted other government assistance programs such as food stamps, have similar requirements.
But her outline scares advocates who see the changes as a way for states to kick millions of adults off the program and undermine its mission of providing health coverage to the poor. They note most nondisabled adults on Medicaid already work. Many who don’t are either too sick, go to school or care for relatives.
“Medicaid coverage is not something that should be earned,” said Robert Doherty, senior vice president at the American College of Physicians. “Medicaid is not a welfare program. It is a health care entitlement program, and anyone who meets the requirements should be able to have coverage.”
Verma’s plan to greenlight work requirements is only just the beginning of dramatic changes, these advocates said. They expect that she would allow more states to charge monthly premiums, as Indiana has proposed; approve drug testing of enrollees, as Wisconsin has requested; and putting a time limit on coverage, as Arizona has asked.
Katherine Howitt, associate director of policy at the Community Catalyst, a consumer health advocacy group that backs the federal health law and expansion of Medicaid, said Verma has thrown open the door to allowing states to add more restrictions on coverage.
“This new approach is not really about promoting work or improving care or improving state flexibility,” she added. “At the end of the day, it is making it harder for low-income people to access health coverage.”
Nearly 75 million people are covered by Medicaid, including 16 million added since 31 states and the District of Columbia expanded their programs under the Affordable Care Act.
Verma said her goal for Medicaid is to move people out of the program by getting them into jobs that offer coverage or provide enough income so they buy it on their own.
“Her comments show she doesn’t understand the reality that many low-wage jobs don’t offer benefits,” Howitt said.
Several states, including Arkansas, Kentucky and Maine, have asked CMS to allow them to require Medicaid recipients to work or do volunteer work as a condition of enrollment. The Obama administration turned down such proposals.
Even some right-leaning pundits say work requirements could backfire because taking away health coverage could make individuals sicker and less likely to hold down jobs.
“This could run counter to the goal of Republicans to help put people to work,” said Jason Fichtner, a health policy expert at the conservative Mercatus Center at George Mason University in Fairfax, Va.
But Josh Archambault, senior fellow for the conservative Foundation for Government Accountability, said he was encouraged by Verma’s approach.
“I think the intent of the program depends on different populations it serves,” he said. “For someone in a nursing home, it’s a health program. But for people in the Medicaid expansion, it is more like a welfare program where able-bodied people are expected to move back into the workforce.”
Congress, with the blessing of President Donald Trump, tried earlier this year to make substantial changes to Medicaid as part of the bills to replace the ACA. Those efforts stalled.
The changes included offering states more flexibility, but federal funding would not be as generous. The nonpartisan Congressional Budget Office said millions fewer people would eventually be covered.
Verma, a former health consultant who helped Indiana expand Medicaid in 2015 under Obamacare, said the law should never have allowed so-called able-bodied adults into the program. That’s because Medicaid already had too many problems, including not enough doctors and wait lists for some people seeking coverage, she said.
Before the ACA, Medicaid mainly covered children, disabled people and pregnant women.
The health law broadened Medicaid to all low-income people, opening up the program to cover nondisabled adults without children with incomes up to 138 percent of the federal poverty level (about $16,600 for an individual).
“We put people on the Medicaid program — able-bodied individuals — in a program that is essentially designed for people that are going to be on the program for the rest of their lives,” Verma said Nov. 9 at an event sponsored by The Wall Street Journal.
Two-thirds of people on Medicaid are disenrolled within three years, according to a U.S. Census Bureau report.
Verma’s pointed criticism of Medicaid, the Affordable Care Act’s expansion and even state officials who helped implement that effort drew rebukes from state Medicaid directors.
Critics said her remarks were misguided and showed she doesn’t understand the program she runs.
Doherty said that by law Medicaid allows states to conduct experiments in how they run the program, but not by making it harder for people to get covered.
Nothing stops states, he added, from offering job training and other programs to help people on Medicaid get back to work. “But we can’t deny them access to health care just because they happen to be poor,” he said.
Robin Rudowitz, a Kaiser Family Foundation policy analyst, said Verma appears willing to let states experiment as never before.
“Some proposals [like work requirements] could create barriers to coverage for eligible beneficiaries and result in losses of coverage for Medicaid enrollees,” she said. (Kaiser Health News is an editorially independent program of the foundation.)
Some health experts said they see many contradictions in Verma’s approach. They said she wants Medicaid to focus only on the most needy — but she has been unwilling to criticize Congress for failing to reauthorize the Children’s Health Insurance Program (CHIP) that covers 9 million children. Federal CHIP funding ran out Sept. 30.
Verma also questioned why some states spend significantly more per enrollee than other states on Medicaid. But the reason, these experts note, is because states have flexibility to vary their benefits, eligibility rules and payments to providers.
As Medicaid has grown to cover more than 1 in 5 Americans, it has become more popular among beneficiaries, health care providers and even among some Republican governors who agreed to expand it. Howitt said the Trump plan would take Medicaid back to the 1980s when it was often linked to cash assistance welfare and carried a stigma.
Joan Alker, director of the Georgetown University Center for Children and Families, said backing work-requirement proposals helps the Trump administration further its ideological message that Medicaid is a welfare program and not a health program.
Judith Solomon, vice president for health policy at the Center on Budget and Policy Priorities, which supports the ACA, said Verma’s vision is simple: to undo the health law’s coverage gains.
“In 2010, Congress decided to expand Medicaid as the vehicle for low-wage workers to have coverage as part of health reform,” she said. “That is still the law and she [Verma] doesn’t get to disagree with that, she has to follow the law not sabotage it.”
–Phil Galewitz, Kaizer Health News
Just the truth says
Trump just wants the rich to get richer and the poor to get really poorer. He will take away any benefits that doesn’t benefit his own pocket or those that contribute to his campaign promises.
He isn’t making America great again, he is making his friends great again. By now it is so obvious who he wants to help and who he doesn’t.
Ask him how much money he still owes Putin?
Just the truth …thank you for your realistic point of the current administration and GOP evil proposals and executive orders.
Exactly what is benefiting his pockets?
Free ride is going to be over.Lowering tax’s and putting more money in the WORKING men and women’s pockets instead of giving it away to people for unnecessary thing other than food like drugs.If I’m wrong drug test welfare recipients and section 8 housing.
Stranger in a strange land says
Well Mark, reducing the cost of programs that help the poor allow Republicans to cut taxes for the wealthy and for corporations. This is why the senate bill eliminates the ACA individual mandate. They have to cut expenses to make tax cuts and not explode the deficit too too much. These tax cuts, when applied to Trump’s leaked 2005 tax return, would have saved him about 20 million dollars and, his heirs will get an additional one BILLION dollars from his estate through the elimination of the estate tax. see:
or google “trump and family could save”
That is how this and similar actions benefit Trump’s pockets as well as the other billionaires and multi millionaires that now populate the Whitehouse. Got it?
Medicaid abuses do exist but a lot of exaggeration had been allowed to be printed without adequate analysis. It’s pure cruelty to force those who are truly sick and poor to work. Those abusing the system should be punished on an individual basis.
Mike B says
Good for Trump. Go Trump go!
To “just the truth” (that’s a joke) and “palmcoaster”, exactly how is this benefiting Trump. I would say it benefits every tax payer, including you. The problem is we have too many people working the system and not working period, time for everyone to have some skin in the game.
The only people “working the system” are actually the wealthy millionaires. . . take a good read and get educated on the FACTS: https://www.washingtonpost.com/news/wonk/wp/2016/10/03/why-thousands-of-millionaires-dont-pay-federal-income-taxes/?ut
Regarding “crazy” trump that some amazingly still support . . . here’s the latest of his asinine conspiracy theories: http://www.cnn.com/videos/politics/2017/11/16/fact-check-donald-trump-barack-obama-philippines-orig-cs.cnn
How incredibly embarrassing to have such a person in “our” White House!
Percy's mother says
The Washington Post is owned by Jeff Bezos, who is known to be very liberal in affiliation.
Why not try to find something to refer to which is not blatantly slanted to the left?
If you want to give a link to an impartial news organization, that’s one thing, but if your “news” source is blatantly liberal you’re not making much of a point.
The people working the system are those on entitlements and are able to work but would rather not. They should be made to work or take away those free bees. Years ago they would dig ditches if the government gave them money. GOOOOOOOOOOOOOO Trump. He’s doing good things..
I wonder if “Percy’s Mother” read the Washington Post article before she replied or if she just assumed the article would be slanted – which it is not – simply because it was published in the Washington Post. She made a foolish/asinine assumption without checking the facts, the same as if I – a liberal leaning, 70 year old, white male, retired professional, disabled vet – would do if I assumed that everything that appeared on the Trumpian propaganda outlet known as FOX news was fake/false simply because it was on FOX News.
OK. . . How about actually “reading” the articles. . . Here’s a similar article from the Atlantic:
Or, how about this one from the New Republic:
Or, this one from MoneyTips:
I could post many, many more articles about how the wealthy use tax loop holes (which are NOT being taken out during this tax “reform”), and how they hide their millions off shore. . . all the while blaming and shaming the poor.
OR, would you prefer to just keep with your prejudices regardless of the facts? Thought so. . .
Remember this is the person “you” put in the people’s white house:
Here’s an analysis of the proposed tax cut:
The middle class will absolutely lose! The wealthy will WIN again! Look, we are now essentially at “full employment”. . . why are wages NOT increasing? It’s because the owners and CEOs are NOT going to share the wealth with you. They are not now, and they will not when their tax cut happens.
“Trickle Down” economics simply does not provide more, higher paying jobs. Lining the pockets of the wealthy is NOT going to make “you” better off. They have been selling that garbage since Reagan. . . called “Reaganomics”.
Remember, doing the same thing over and over. . . while expecting a different result. . . is a definition of insanity. Let’s all become SANE and actually “think”. . . OK?
On “trickle down” economics. . . this from the Associated Press. . . or are they also too “not FOX” for ya?
a tiny manatee says
It helps to remember that the same people still supporting trump at this point are entirely ok with his and his administration’s behavior. That means that they’re ok with everything that this administration’s done up to this point, including open collusion with a hostile nation, destroying america’s image with respect to the rest of the world, and dismantling policies and departments put in place to maintain the day to day operations of the nation and help insure the safety of the american people within their own nation or abroad as long as it gets their own agendas enacted, and this is one of them.
So let that sink in next time you drive past a handful of flag waving trump supporters or see someone driving down the road with a make america great again sticker. What they think is great and what they think that flag represents as they wave it isn’t america.
Trailer Bob says
“They note most nondisabled adults on Medicaid already work. Many who don’t are either too sick, go to school or care for relatives”
Really? What world do you live in. I worked for 35 years as a Certified Financial Planner, retiring just recently, and I have seen way too many people who were very able to work, but were satisfied trading the need to work for a free paycheck. I have met many large families who don’t have but maybe one person who is working. Medicaid is extremely abused. OBamaCare is even worse, as to get free health insurance financial assets are not included in the requirements. According for the Kaiser Family organization, more than half of all bills for childbirth in US hospitals are paid for by Medicaid, so you going to tell me all those people cannot work, but they can have multiple babies? We had better wake up before the rest of us who do work just decide it isn’t worth it.
Instead of continuing to blame and shame the poor and just “ASSUMING” that Medicaid fraud is only about
ineligible people signing up. . . let’s look at some actual FACTS about who exactly is taking tax payers’ millions. . . It’s the “DOCTORS”, and other medical providers. . .
This from Kaiser Health News. . . stating 412 medical professionals caught in defrauding health care programs. . . take a good read:
Medicaid work requirement should have been implemented long ago. It is about time life time dependents of the system started doing something. This country can’t afford to take care of people who are just too lazy to do for themselves. Maybe doing something will bring fourth energy, skills and confidence and they can get off the tit of the government. Way to go Mr. Trump!!
@Republicans can’t handle the truth – or speak it
federal revenue by state