The governor of Kentucky, Republican Matt Bevin, has won a waiver to institute work requirements for Medicaid recipients to continue being covered, and although there has already been talk of court challenges—Democrats feel that imposing a work requirement on some of the poorest and sickest in the U.S.—Bevin is determined to proceed.
In fact, according to The Hill, he’s already issued an executive order declaring that if any part of his waiver is struck down—it not only imposes a work requirement on “able-bodied” Medicaid recipients, but also imposes premium payments and will lock beneficiaries out of coverage if they don’t pay up—he’ll end the whole Medicaid expansion.
Medicaid was expanded by Bevin’s Democratic predecessor Steve Beshear, and Bevin ran on a platform that promised to end it. The hitch is that if he does so, about 480,000 people could stand to lose their coverage—and as it stands, if the waiver goes unchallenged, a McClatchy report says that 100,000 could lose coverage just based on the work requirement.
“Able-bodied” adults, says the report, “who don’t complete 80 hours per month of ‘community engagement activities,’ like employment, education, job-skills training and community service,” would be thrown off Medicaid—and Bevins is betting that he won’t get any blowback over it in red-state Kentucky, where support tends to run high for work requirements.
Al Cross, editor and publisher of Kentucky Health News and a former state political reporter for the Louisville Courier Journal, is quoted in the report saying, “If you can say, ‘All we’re doing is requiring people to be more active participants in their health care and require some work-related activities,’ I think the general population looks at that and says, ‘What’s the matter with that?’”
Cross explains in the report that “In this state and lots of low-income states, there’s a strong level of resentment” for people receiving government-subsidized health care as working people can have a hard time paying for their own coverage.
And Kentucky, the first state to receive a waiver and impose work requirements, is apparently not all that different from other states; according to a Kaiser Family Foundation poll from 2017, 70 percent of the public supports work requirements for Medicaid recipients.
But in other states, the political dynamic could differ substantially—so while Bevins may be insulated for his actions, the eight other Republican governors who have also asked for waivers may not have so easy a time of it.
In fact, it may not play all that well in Kentucky, either, once it kicks in. The report cites another Kaiser Family Foundation study that estimates that 60 percent of Medicaid enrollees are already employed, and 35 percent of nonworking Medicaid enrollees say illness or disability is the main reason for their unemployment. Other reasons cited heavily for not working include caretaking obligations (28 percent) and attendance in school (18 percent). Incidentally, Kaiser also reported that women made up 62 percent of Medicaid recipients without jobs in 2015.
Burdett Loomis, a political science professor at the University of Kansas, is cited in the report saying that the work requirement policy, considered against the total of Kaiser’s findings about the unemployed who are Medicaid recipients, could make that work requirement policy mostly symbolic.
He’s quoted saying, “It ends up playing to this notion that all these people are getting something for nothing, when, in fact, if you look at Medicaid that’s really not the case.”
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