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Paul Gibbs: Medicaid work requirements don’t work

Ma Black, left, and Beth Armstrong, center, supporters of a voter-approved measure to fully expand Medicaid gather others at a rally to ask lawmakers not to change the law during the first day of the Utah Legislature, at the Utah State Capitol, Monday, Jan. 28, 2019, in Salt Lake City. (AP Photo/Rick Bowmer)

Many decisions have been made by Utah’s state government during the pandemic, both good and bad. One of the wisest decisions has been temporarily suspending the work reporting requirement in Utah’s Medicaid expansion waiver. This has made a profound difference in the lives of Utahns, allowing thousands to receive and maintain health coverage without battling mountains of paperwork.

However, in the recent special session of the Utah legislature, Medicaid work requirements were briefly revisited for future consideration by the Social Service Appropriations Committee, including the possibility of extending these requirements to medically complex enrollees, parents and youth who age out of foster care. People we should be looking to protect, not over burden.

Let’s examine again why this deeply flawed policy idea doesn’t promote self-reliance or fiscal responsibility as advertised, but is an impediment to both.

First, work requirements are directly contrary to the express purpose of Medicaid, which is to provide care, not to make getting it harder for those who need it. This simple legal fact is why work requirements have been shot down by federal courts in Kentucky and Arkansas, resulting in other states, such as Arizona and Illinois, reversing similar policies.

State officials argue that Utah’s “work effort” is different, as it requires an effort to get work by filling out and submitting a mind-numbing 48 job applications in a three-month period rather than a required number of work hours.

This misses the point: It mandates an absurd amount of paperwork, including online screenings and trainings, job applications and reporting back to the state on all 48 applications. This is a heavy burden, and seems all the more pointless when we recognize that the majority of those in the expansion population who can work already do.

Utah’s plan would result in many who need help but are unable to meet the burdensome requirements losing access to care. This doesn’t help people to become employed or self-reliant, it penalizes them for having difficulty navigating the bureaucracy or being unable to scale the Mount Everest of paperwork.

Building these kinds of cracks into a system guarantees people will fall through them. In fact, that is their purpose. Any “savings” to the state budget predicted to result from work requirements are explicitly due to low-income people losing care. In the end, whether reporting hours worked or jobs applied for, it’s equally contrary to the purpose of Medicaid, and therefore at best on shaky legal ground.

Not only is this added bureaucratic red tape burdensome to those seeking coverage, it’s burdensome to the state. When the independent Government Accountability Office analyzed the cost of implementing work reporting requirements in five states, they discovered it cost taxpayers an extra $408 million over three years due to the administrative burden of implementing and enforcing the rules.

Where is the fiscal responsibility in that? Why spend all that money to avoid helping people? This doesn’t fit with Utah fiscal or moral values.

The facts demonstrate that the best way to promote self-reliance among the Medicaid population is Medicaid itself. When people get the help they need to get healthy, they are better able to work and take care of themselves.

The Utah way is not to deny people the means to become healthy and therefore more self-reliant, nor to spend unnecessarily to do so. It is to love our neighbor by reaching out with a compassionate hand up while maintaining responsible stewardship of our resources. Reversing a wise decision by bringing back the Medicaid work requirement would be a step in the wrong direction for Utah and its people.

Paul Gibbs

Paul Gibbs is an independent filmmaker, health care activist and former Medicaid patient living with this wife and two sons in West West Valley City. His insights on health care issues can be found at entitledtife.net, and on the podcast “Entitled to Life,” available on Spotify, Anchor and other platforms.

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