Republicans recently released their proposed plan to cut $715 billion in federal health care spending over 10 years. While they position changes to Medicaid as removing waste and not cutting eligibility, don’t be fooled by that spin. The only thing this plan will do is strip health coverage from an estimated 8.6 million Americans to fund tax breaks for the wealthy.
Central to the proposal is the implementation of national work requirements for Medicaid members. To demonstrate eligibility, not only would individuals have to provide proof that they are low-income, but adults without dependents would also have to prove that they worked or volunteered at least 80 hours per month. The bureaucratic red tape alone will cost millions of eligible people their coverage.
Most adults with Medicaid who can work, do work. The perception that some able-bodied adults are passing on work opportunities because they have health coverage through Medicaid simply isn’t supported by the nation’s current 4.2% unemployment rate. The notion has also been debunked by both the Congressional Budget Office and analyses of work requirement attempts in other states.
Advocates of work requirements overlook a plain economic truth: A healthy population is essential to a productive national workforce. Work requirements would actually undermine economic growth by taking away access to care for those who need it most, including gig workers or those with minimum-wage jobs.
Without health coverage, individuals will be sicker, more likely to miss work or not be able to hold a job, thus trapping them in a cycle of poor health and poverty. With health coverage, individuals are better able to hold down a job, support their family, and ultimately reduce their reliance on Medicaid and other forms of public assistance.
Work requirements are unlikely to drive more people into employment but will certainly result in preventable loss of coverage, illness and death. It will also hit us economically. With fewer healthy people contributing to the economy, The Commonwealth Fund estimates that Illinois could lose up to $2.5 billion in gross domestic product and $214 million in taxes.
Moreover, work requirements, plus the proposal to check members’ eligibility twice a year instead of once, exponentially increases program bureaucracy at both the state and federal level. Ironically, this could negate savings and the administration’s intent to shrink government spending and the workforce.
We can look at Arkansas as an example. When the state implemented work requirements in 2018, more than 18,000 people lost their health insurance in the first four months. Of those who lost coverage, 97% were actually compliant with the rules but still got kicked out of the program due to excessive red tape. There was also no increase in employment or hours worked. Arkansas spent an estimated $26 million to implement the program, which had to be halted by a federal judge.
Work requirements won’t just hurt individuals with Medicaid coverage. They will have trickle-down implications for everyone’s medical care. The costs to care for more uninsured and sicker patients end up coming full circle in all of our health insurance premiums, as well as Medicare and Social Security expenses.
The increase in patients without insurance will also compound financial pressures on hospitals, doctors’ offices, nursing homes and mental health providers. We will likely see service reductions and even closures, affecting wait times and access for everyone.
Medicaid work requirements are not only ineffective but also counterproductive, and they threaten to destabilize the very foundation of our country’s health care system. The proposed changes to Medicaid would reduce coverage for low-income individuals, place overwhelming burdens on health care providers — worsening both health outcomes and economic vitality — and increase government bureaucracy.
Considering we are the world’s richest country, it’s unconscionable that the federal government would take away health insurance from millions of Americans in order to subsidize tax breaks for the highest earners.
Toni Preckwinkle is president of the Cook County Board of Commissioners. Dr. Erik Mikaitis is CEO of Cook County Health.
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