It's Not Clear How Many People Could Actually Work To Get Medicaid

Mar 21, 2017
Originally published on March 21, 2017 11:50 pm

Republican House leaders are making last-minute changes to their health care proposal in a bid to woo more conservatives ahead of a vote scheduled for Thursday.

One of those changes would let states impose work requirements on some Medicaid recipients. A handful of states asked the Obama administration for that authority but were denied.

To further examine how requiring millions of Medicaid recipients to work could impact lives across the country, NPR's Audie Cornish spoke with Leighton Ku, a professor of health policy at George Washington University. The interview has been edited for length and clarity.


Interview Highlights

On whom this requirement could affect

The way it's written right now, it might affect millions of adults on Medicaid who aren't elderly, disabled or pregnant. They could be required to work to get their health insurance.

Among the people who enrolled in Medicaid under the expansion, about 13 percent might be considered able-bodied but not working right now. Of those, the great majority said the reason they weren't working was because they were taking care of family members. If you look across the nation, it might be millions of individuals who receive Medicaid benefits at the moment but potentially could be required to work under the rules Congress is considering.

On why requiring people to work to get Medicaid could prove problematic

Most Medicaid recipients want to work, and a majority of those on Medicaid [who can work] are already working. The problem is that many of them live in places where jobs aren't available or they don't have the right sorts of skills. Others have health problems or family obligations, or in some cases they're trying to better themselves in other ways like going to college.

If someone is going to college to get training so they can have a meaningful job later on, that doesn't count as meeting the work requirement in these policies. There are people who are trying to better themselves [but] have problems, whether related to work or family obligations, and this'll say, "You can't keep your health insurance anymore."

I disagree that this creates opportunity for people. People already had the opportunity to go look for work and get job training. This will actually disallow some of them to pursue other opportunities.

On how requiring work for health insurance differs from requiring work for food stamps

There are some work requirements in the food stamp program (SNAP). But that makes a little more sense in this context: If people work, they'll make more income and help make them economically self-sufficient. In the context of Medicaid, that makes less sense. Only a quarter of jobs available to people enrolled in Medicaid offer health insurance to their workers. It's not as though work requirements get them to the point where they'll be self-sufficient with respect to health insurance coverage.

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AUDIE CORNISH, HOST:

Republican House leaders are making last-minute changes to their health care proposal in a bid to woo more conservatives ahead of a vote scheduled for Thursday. One of those changes would let states impose work requirements on some Medicaid recipients. A handful of states asked for that authority from the Obama administration but were denied. Here's Arkansas Republican Governor Asa Hutchinson.

(SOUNDBITE OF ARCHIVED RECORDING)

ASA HUTCHINSON: You're talking about healthy individuals that are capable of working that might need training, that might need opportunities. And we want to be able to have that to be a part of the Medicaid expansion program.

CORNISH: For more on this idea of requiring Medicaid recipients to work, we're joined by Leighton Ku. He's a professor of health policy at George Washington University. Welcome to the program.

LEIGHTON KU: Thank you very much.

CORNISH: We heard the Arkansas governor there talking about this concept. What do you think is the overall goal? What are people expecting to happen if they add a provision like this?

KU: I think that they believe that millions of people will no longer be enrolled on Medicaid and that those are people who they feel are not meeting their social obligation to try to work. I think people think that it might help more people work. That remains to be seen.

And I guess that's a tradeoff. If some people - some additional people work because of this requirement, how do we decide to trade that off against the millions who might lose their health insurance because they are unable to find meaningful work?

CORNISH: So you've studied the population of people who enrolled in Medicaid under the expansion under the Affordable Care Act. So what does the data tell you? How many people out there are able-bodied and, like, not looking for work or not in school or not pregnant?

KU: So when we looked at the people who were in the expansion population, about half of them were disabled or had serious health problems. Of the other half of the group, the great majority were already working or looking for work or in school. So there is a portion, about 13 percent or so, of these adults who might be considered able-bodied but not working right now. And of those, the great majority said the reason they weren't working was because they were taking care of family members.

So there are some - and probably if you look across the nation it could be millions of individuals - who are receiving Medicaid benefits at the moment but who would be potentially required to work under the new rules that Congress is considering.

CORNISH: Now, proponents of this idea said it would be like the work requirement for some recipients of food stamps that was part of the welfare overhaul in the '90s. What do you make of that comparison?

KU: Well, there - there are some work requirements that already exist in the food stamp program now called SNAP. But that makes a little more sense in the context in which you think if people work, they will earn income and that can help make themselves economically self-sufficient.

In the context of Medicaid, that makes less sense because only about a quarter of the jobs that are available to people who were in the Medicaid sort of range offer health insurance to their workers. It's not as though work requirements get them to the point where they're going to be able to be self-sufficient with respect to health insurance coverage.

The other thing where I would disagree somewhat with Governor Hutchinson is he says this is creating opportunity for people. People already have the opportunity to seek work, to get job training. This will actually disallow some of them who are trying to pursue other opportunities. So, for example, if someone is going to college and trying to get training so they can have a meaningful job over time, guess what? That doesn't count as meeting the work requirements under these policies.

CORNISH: Leighton Ku is director of the Center for Health Policy Research at George Washington University. Thank you for speaking with us.

KU: It was nice to be here. Transcript provided by NPR, Copyright NPR.