HEALTH CARE/Joan Retsinas

Work Makes You Insured

The Nazis extolled the virtue of work, cruelly mocking the inmates marching to the crematoria. “Arbeit Macht Frei” [Work makes you free] greeted the inmates. The phrase tied “work” to freedom, ironically foretelling the doomed prisoners’ release from Nazi brutality.

This Trump Administration also extols work. Everybody should work: people on welfare, people receiving housing subsidies, now people who receive Medicaid.

Fox News asks: “Why are 28 million able-bodied adults on Medicaid?”

Making the idlers work will make them healthier. The Administration has taken the correlation between income and work (wealthy people are, statistically, healthier than poor people), and jumped to assert that “work requirements” will make Medicaid recipients healthier – an assertion even conservative economists reject.

Conservative economists, though, recognize the fiscal benefits to hard-pressed states. Dropping people from the Medicaid rolls will lower the overall tab. Of course, the risk – more the reality - is that those ex-recipients will join the ranks of the uninsured. And maybe – optimistically — those new workers will gravitate to their employers’ insurance rolls. For conservative think-tanks, making Medicaid recipients work is a fiscal win. For this President, “work requirements” are a really great idea.

This Administration’s bureaucrats should look at the statistics. Most people on Medicaid work. When Congress drafted the expansion of Medicaid under the Affordable Care Act, the intent was to cover the “working poor.”

Today one in four Americans (75 million) have Medicaid. In California Medicaid covers 13.5 million residents. Thirty-six percent of New Mexicans hold a Medicaid card (the highest percentage in the nation), compared to 9.2% of Utah residents (the lowest).

The proponents of “work” as a really great idea should take a break from their golf-conferences to eavesdrop in the waiting room of a health clinic. Medicaid patients rarely work at full-time salaried jobs, with paid vacations, healthcare, and pension plans. Instead, many work “under the table,” at part-time jobs that pay the minimum wage. They work irregular hours, with gaps in employment as seasonal layoffs drive them on and off the workforce. All the while, they juggle family strife, addictions, evictions and illnesses. They worry about transportation – cars, Uber, friends-with-cars are luxuries. They worry about their children’s illnesses, about day care, about deteriorating apartments. Yet they work.

Some of those people waiting to see a nurse-practitioner (the triage-person) have disabilities and illnesses that make them, literally, too ill to work. States will exempt them (along with children) from work requirements. And some of those waiting cannot find jobs they can do: in swatches of the country, where unemployment rates remain high, able-bodied job-seekers continue to seek. Congress will let states exempt those “seekers;” yet, as the Washington Post reports from its scrutiny of states’ exemptions, the exemptions favor the rural white voters – the ones who supported the president. Consider: Michigan exempts residents in mostly-white rural counties, where the unemployment rate exceeds 8.5%, but not in mostly-black Flint or Detroit.

Finally, some Medicaid-recipients do work in the profitable corporate sector, in the Walmarts et al. Those low-wage workers could be covered under their employers’ health insurance; instead, they crowd under the Medicaid tent. They get better coverage, at a lower cost to them (and no cost to their employers). Industry apologists point out that legislators designed the expansion of Medicaid to cover low-wage workers who couldn’t afford their employers’ policies. (www.investors.com/politics/editorials/myth-busted-taxpayers-are-not-subsidizing-wal-marts-low-wages/) So it is no surprise that, from the start, savvy employers dumped their low-wage employees, particularly their new hires, onto the Medicaid rolls. Benestream, a “Medicaid Migration” company, promises to help employers negotiate the Medicaid system. Rhode Island Public Radio estimates 360 employees of firms that include Citizens Bank, CVS and Electric Boat are covered under Medicaid. Faced with mounting Medicaid tabs, some states have fought. Consider Massachusetts’ “Shame legislation.” The state would make public the 50 employers with the largest number of employees on Medicaid. Massachusetts’ Gov. Charlie Baker (R) instituted a $750/per-employee levy on employers. Yet states that rush to retransfer (a reverse “Medicaid migration”) low-wage retail employees out of Medicaid to their employers’ policies risk alienating those employers — a Scylla and Charybdis choice.

Work remains a virtue. So is compassion. Most able-bodied Medicaid recipients who can find work are already working. Work requirements will pare the red ink in states’ budgets, yet strip some people of insurance. A really cruel idea.

Joan Retsinas is a sociologist who writes about health care in Providence, R.I. Email retsinas@verizon.net.

From The Progressive Populist, July 1-15, 2018

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