Would work requirements for Medicaid lead to higher employment? Evidence says no | Opinion

• Ohio Gov. Mike DeWine has proposed attaching work requirements to Medicaid.
• Work requirements do little to increase employment, and they often diminish health care, Michael Douglas writes.
• Instead, to increase employment and health care, it's better to target structural barriers, an author at the Brookings Institution recently argued.

Mike DeWine sounded so reasonable as he recently explained why Ohio would benefit from attaching work requirements to Medicaid. The governor argued that the state has “a responsibility to make sure as many Ohioans as possible are on a pathway to financial independence.”

He added that the requirements would “promote self-sufficiency,” “purpose and pride,” while improving the “well-being” of the state’s workforce. Maureen Corcoran, the state Medicaid director, touted the opportunity to encourage “healthier communities” and a “thriving” state economy.

The proposed requirement calls for adult recipients up to age 55 to be employed, enrolled in school or job training or a recovery program, or have a serious mental or physical illness.

Those who benefit offering something in return, essentially health care for work, unless they qualify for an exemption − what’s not to like?

This is one of those examples of what may sound fair-minded, yet upon closer inspection falls apart.

In seeking federal permission to attach the requirements, the governor and fellow Republicans in command of the legislature run counter to evidence established through years of experience.

Work requirements do not deliver as promised. They do little to increase employment. More, they often have the perverse effect of diminishing health care as those eligible encounter administrative barriers and find themselves without access to the coverage they need.

Consider the outcome in Arkansas, which launched work requirements in 2018. Things quickly turned sour. Roughly 18,000 recipients lost coverage within one year. They did so not so much because they failed to meet the requirement to work at least 20 hours per week. Rather, they struggled with the maze of documentation. Some lacked internet service or ran into trouble verifying exemptions.

A 2020 study published in Health Affairs found no increase in employment. What it did discover is that those Arkansas residents between ages 30 and 49 who lost coverage faced adverse outcomes in the shape of increased medical debt, plus delayed care and medication due to cost.

Worth emphasizing is that most Medicaid recipients already work. Thus, the work requirements target a sliver of those in the program. A study by the Center on Budget and Policy Priorities cites how the requirements are more likely to harm people with disabilities, women, rural residents and those performing low-wage jobs with unreliable hours.

Many may not qualify for an exemption, yet they are hardly shiftless or somehow undeserving. Estimates are around 62,000 Ohioans could lose their health coverage under the work requirements.

One analysis puts the number in the hundreds of thousands.

Poverty is complicated. Unfortunately, advocates for work requirements often suggest the remedy is simple. They invite the impression of moral failure: The poor are lazy and need only a push or a kick. As a result, their policy-making looks more like punishment than problem-solving.

Enhance lives by denying health care coverage? If anything, Medicaid puts people in a position to find work and sustain employment. For starters, they are healthier. More broadly, they are empowered to succeed, health care serving as part of a larger support system.

This is the thinking behind the $1,000 child tax credit for low-income and middle-class families proposed by the governor in his state budget plan. Such measures, including food assistance, really do promote financial independence and the “well-being” of the workforce, not to mention the community as a whole.

No surprise, then, that a 2023 Congressional Budget Office analysis also concluded that the punitive approach would add to the uninsured and deliver “no change” in employment for Medicaid recipients.

As Farah Khan of the Brookings Institution recently argued, better to target the structural barriers to employment through steps such as effective job training, child care, transportation assistance — and access to health care.

As it is, the assumption at the root of work requirements is that people will find employment and thus qualify for coverage. The trouble is, the evidence reveals that would not be the outcome. Why not skip the turmoil and ensure the coverage is there?

The Medicaid expansion, set in motion by the Obama White House and a Democratic Congress, and embraced by John Kasich during his time as governor, was a signal achievement for Ohio. Most important, it brought treatment to many Ohioans with mental illness. The work requirements would erode this advance.

They aren’t the only harm looming. The Republican majority in U.S. House has unveiled a budget framework that all but guarantees deep reductions in Medicaid, almost certainly through similar work requirements. The Energy and Commerce Committee has the task of finding $880 billion in spending cuts. Virtually all the spending the panel oversees involves Medicare and Medicaid.

Yet the same reality applies. Will lawmakers follow their ideological leanings or the evidence that work requirements do not work?

Michael Douglas is a former Beacon Journal editorial page editor. He can be reached at mddouglasmm@gmail.com.