How executing a new GOP proposal could be 'Kafkaesque nightmare'

The House Republican budget plan that narrowly passed Wednesday includes a provision that would add a work requirement for Medicaid recipients.

It’s an idea that polls well, even among Democrats.

But data suggests that an idea that may sound good to the layperson in a focus group doesn’t always work out so well in the real world, columnist Catherine Rampell writes for The Washington Post.

Rampell describes the work requirement as a “solution in search of a problem.”

“Worse than that, they will create significant new problems, particularly among the vulnerable population the policy is supposed to help.”

The proposal is based on the demonstrably false notion that Medicaid recipients are mostly slackers.

According to data compiled by the Kaiser Family Foundation, around 60 percent of nonelderly Medicaid recipients are already employed, and most who are not are disabled or have serious medical conditions, caregiving obligations, or enrolled in school.

Rampell acknowledges that the idea of implementing a work requirement would “nudge” the approximately 9 percent of Medicaid recipients who are not working due to retirement, inability to find work, or other reasons may sounds appealing.

“In theory, this sounds reasonable,” Rampell writes. “In practice, implementation can be a Kafkaesque nightmare.”

Rampell notes that Arkansas in 2018 tried enforcing a Medicaid work requirement and it didn’t go well.

“By the time a federal judge paused Arkansas’ experiment less than a year after it launched, 18,000 lower-income people had already been purged from the state Medicaid rolls — and not necessarily because they were failing to work 80 hours a month, as the state required (and as the new House GOP bill would mandate, too),” Rampell writes.

“Many were working but found it challenging to prove to the state that they met the ‘community engagement’ requirements or allowable exemptions. That’s because the reporting process was confusing and onerous.”

An Arkansas poultry plant employee in 2018 told Rampell the Medicaid work requirement led to disastrous consequences.

Adrian McGonigal had difficulty navigating the state’s website and couldn’t properly log his hours. That led to him being disenrolled from Medicaid, he fell ill when he couldn’t afford to pay for his COPD prescriptions. He ended up in the emergency room and lost his job because he missed too much work.

“In other words, for people such as McGonigal, access to health insurance and care should be seen as a work support, rather than a work disincentive,” Rampell writes.

Rampell doesn’t dispute the goal of encouraging people to find work, in theory. It’s the way proposals such as this are implemented that she finds problematic.

“Helping more people find work, and move up the income ladder, is a worthy goal. But there’s little evidence that this particular policy would achieve that. It didn’t in Arkansas, and the Congressional Budget Office expects that the version included in the House bill wouldn’t, either,” Rampell writes.

“In a letter on Wednesday, the CBO concluded the measure ‘would have a negligible effect on employment status or hours worked by people who would be subject to the work requirements.’”