Kentucky on Friday became the first state to win approval from the Trump administration to impose strict work requirements on its Medicaid beneficiaries.
The state will require able-bodied adults without dependents to work at least 80 hours a month to qualify for coverage.
The state will also require people who gain coverage through the Medicaid expansion to pay monthly premiums, based on income levels.
Kentucky is one of ten states seeking waivers to require certain Medicaid beneficiaries to work in order to be eligible for the program.
The approval comes just one day after the federal Centers for Medicare and Medicaid Services announced new guidance intended to encourage states to apply for such waivers, something that has never before happened in the 50-year history of the Medicaid program.
“CMS has long supported policies that recognize meaningful work as essential to the economic self-sufficiency, self-esteem, well-being, and improved health of people with disabilities,” the agency wrote in its approval letter to the state.
“Given the potential benefits of work and community engagement, we believe that Medicaid programs should be able to support these activities and test incentives that are appropriate for this population and lead to improved health outcomes,” the agency wrote.
Kentucky Gov. Matt Bevin (R), a fierce opponent of ObamaCare, was elected in 2016 partly on a promise to change the state’s expansion of Medicaid that came as part of the law.
Bevin has said the program is not fiscally sustainable, but the state’s uninsured rate has fallen from about 20 percent in 2013 to less than 8 percent by 2016 -- among the largest coverage gains in the country.
The waiver also would impose a six-month coverage lockout if Medicaid beneficiaries get a new job or a new salary and don’t tell the state.
I fully expect Kentucky's uninsured rate to skyrocket back into double digits, along with the state's mortality rate. This is going to start killing people, full stop. People aren't going to be able to afford Medicaid premiums, they aren't going to be able to keep and hold jobs because of illness in a right-to-work state where one missed shift means you lose your job.
What if you get laid off? What if you're, say, one of the Sam's Club workers living in Kentucky on Medicaid and you show up to work only to find your store permanently closed with no warning?
Oh well, there goes your Medicaid. Sorry. There goes your health care. There goes your livelihood, because now you're out of the program and too sick to go around hunting for a new job.
The issue with work requirements for Medicaid isn't to help "transition people to better outcomes" it's to punish people until they drop out of the program so the state spends less money on them (and if they die, bonus!)
The vast majority of able-bodied, adult Medicaid recipients are in families where at least one adult is working and qualify for the program because they have low-paying jobs that may not even offer health benefits, let alone insurance these workers can afford.
And never mind that there are a lot of good, sometimes unavoidable reasons why even a part-time job isn’t an option for people who, say, have chronic illnesses not severe enough to constitute a disability; or who are caring for an ill or elderly relative; or who are full-time parents; or who are enrolled in school.
And the next time the unemployment rate spikes and people find themselves out of work and uninsured, these work requirements are going to make it even harder for them to keep their lives together.
The policy the Trump administration is enacting are based not on data but on an ugly stereotype many Americans hold about people who rely on Medicaid and other programs to get by. Accordingly, 70 percent of Americans said they supported work requirements in Medicaid in a survey the Henry J. Kaiser Family Foundation conducted in June.
Imagine Ronald Reagan’s “welfare queen,” only this time she has diabetes and can’t be on her feet all day. The Trump administration’s solution to this woman’s problems is to make it harder for her to see a doctor and fill her prescriptions, so she gets sicker and is less likely to find steady work.
That's exactly who's going to lose health coverage and won't be able to afford insulin shots. And there are going to be tens, if not hundreds of thousands of cases like this in Kentucky.
“With the approval of the Medicaid waiver, the historic progress Kentucky has achieved in health care in recent years comes to a halt,” said Dustin Pugel, a policy analyst with the Kentucky Center for Economic Policy. “New barriers to getting covered and new ways of getting kicked off coverage will hurt working Kentuckians, health care providers and our economy. Rather than saving monies, the waiver creates new costs in expensive bureaucratic systems and reductions in the health of our workforce. These radical and counterproductive changes will result in nearly 100,000 Kentuckians losing coverage."
So now it's not Matt Bevin kicking tens of thousands off Medicaid, it's those lazy people who are kicking themselves off.
Because basic health care isn't "sustainable" for Kentucky. And apparently neither are good schools, working roads and bridges, clean water, reliable sanitation and power and internet access. Bevin has trashed all that in the two years he's been in office.
And now he's wrecked Medicaid expansion, just as he promised he would. And we voted for him anyway. Congrats, Kentuckians. You just signed your own death warrants because you hate Obama that much.