New Medicaid threat emerges
Helping people who can work find good-paying jobs is good for families and good for Iowa's economy. But taking health coverage away from people who don't meet rigid reporting requirements won't achieve that goal. In fact, it will only make it harder for people to work and take care of their families.
We are deeply concerned about a bill introduced today that would have Iowa apply to the federal government for a waiver to require low-income adults covered by Medicaid to report monthly so-called "community engagement" activities to retain their coverage. Those activities are 20 hours or more per week of either work, a work program or volunteering (or certain combinations of those), or participating in the state's TANF employment program, PROMISE JOBS. It would provide limited exemptions, including to people who are "medically certified as physically or mentally unfit for employment," pregnant or caregivers to infants or children with certain special health needs.
It's a damaging bill, and no tweaks can fix it.
The fact is that 72 percent of adult Iowans on Medicaid are already working. Nationally, nearly 80 percent of those not working are in school or have an illness or disability or caregiver responsibilities that keep them from doing so.
This bill calls for no additional resources to help people navigate the reporting requirements or train for or get a job. It would add layers of red tape to qualified people just to prove they are already working, caregiving or sick. It represents a costly new burden on our state that would require a massive new reporting system to track participants' work hours and exemptions.
The result is that Iowans will lose their health care. In Arkansas, which implemented similar reporting requirements, more than 18,000 people have been dropped from Medicaid since last August. Among them are working people whose jobs offer unreliable hours at low wages and who face barriers to complying with reporting requirements. It also includes people in exempt groups—individuals with disabilities and serious health conditions and caregivers—who struggle to navigate the red tape to provide required documentation.
What's even more outrageous is that Arkansas' requirement isn't even promoting employment. In November 2018, only 0.5 percent of the beneficiaries subject to the requirement reported new work hours in response. Some of whom likely would have found work anyway. The majority were already working or meeting existing requirements in other ways.
Medicaid is itself a work support. It makes affordable health coverage available to low-wage workers whose jobs don't offer it and helps people with chronic illnesses, like diabetes or lung disease, control these conditions so they can work (check out this PBS NewsHour video about to see how losing Medicaid derailed the life of one Arkansas worker).
If building up Iowa's workforce is really the goal, Iowa lawmakers should instead embrace strategies with a proven track record: expanding high-quality job training, child care assistance for low-income working families and a decent minimum wage.