Public health professors push back against health care work requirements

Media Credit: Keegan Mullen | Staff Photographer

Sixteen public health professors are urging a D.C. court to overturn a federal initiative allowing states to impose work requirements on Medicaid users.

Updated: May 9, 2018 at 1:44 p.m.

Sixteen public health professors are urging a D.C. court to overturn a federal initiative allowing states to impose work requirements on Medicaid users.

The Centers for Medicare and Medicaid Services announced in January that states can now apply for waivers to force Medicaid recipients to provide proof of employment before receiving health benefits. Since then, three states have submitted waivers and been approved. Fifteen Medicaid enrollees from Kentucky – the first state to be granted a waiver – filed a lawsuit in January attempting to block the policy from going into effect.

In response to the lawsuit, 43 public health professors nationwide, including GW faculty members, collectively filed a “friend of the court” brief with D.C.’s U.S. District Court earlier this month. The complaint says the requirement, which would leave tens of thousands of people without health care, will spread nationwide if not stopped in Kentucky.

About 20,000 people in Kentucky could lose health coverage within the first year of the new health care policy, and after five years, almost 100,000 people could lose their coverage, according to federal data cited in the brief. But researchers found that the number of people who could lose their coverage over five years is actually between 175,000 and 300,000, according to the brief.

Researchers evaluated the past impact of work requirements on food stamp recipients – which made thousands ineligible for the benefit – and concluded that a similar result would occur if the Medicaid stipulation was imposed.

Lynn Goldman, the dean of the Milken Institute School of Public Health, was one of eight public health deans who collaborated on the brief. Goldman was not available for comment.

Sara Rosenbaum, a professor of health law and policy who helped conduct the research and write the brief, said the federal government should not have the authority to reduce health insurance benefits when it will cause thousands to lose their health care.

“That is not how this particular demonstration authority is supposed to be used, to strip people of their health insurance, particularly on the grounds that it’s going to improve their health,” Rosenbaum said.

Rosenbaum said the policy shift does not align with the objective of Medicaid, which is meant to alleviate the cost of health care for low-income populations, which often includes people who are unemployed.

“There was no evidence that taking away insurance from people and making them dependent on employer coverage – when they’re this poor and unable to find jobs that have employer coverage in any way – furthers the objectives of the Medicaid program,” she said.

Leighton Ku, a professor of health policy and management and director of the Center for Health Policy Research who worked on the brief, said the federal policy shift was based on the assumption that work improves a person’s health, which isn’t always the case. He said there is an association between work and health – but only because people who are healthy are often able to work.

“The reality of the matter is they don’t help beneficiaries in the way they expect, and the cost is that large numbers of people will lose their health insurance coverage, and because of this will have a much harder time getting health care,” he said.

Peter Shin, an associate professor of health policy and management who contributed to the brief, said reducing access to Medicaid will have a negative impact on the health of the population of the state, especially for those who are unemployed. He said that better access to health care has been shown to improve health overall.

“Medicaid has been shown to make a tremendous impact in terms of health care access, which is tied to health care outcomes, and of course down the road to health care costs,” Shin said.

Shin said he hopes the brief will encourage the government to reassess the impact that reducing access to Medicaid will have on low-income populations and perhaps lead to a policy change.

“Hopefully it will sway them a little bit in terms of either pulling back on what they want to do with work requirements, as well as looking at some of the legality of what they can actually do,” he said.

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