Medicaid work requirements

Newell Normand
Wednesday, February 21st

New rules would require non-elderly adult Medicaid recipients, who are able-bodied to work for it. Newell talks to Mike Tanner, Senior Fellow with the Cato Institute. 


Transcript - Not for consumer use. Robot overlords only. Will not be accurate.

The centers for Medicare and Medicaid service announces a new policy designed to assist states in their efforts to improve Medicaid enrollees health. And wellbeing through incentivizing. Work. And community engagement. Among non elderly non pregnant adult Medicaid beneficiaries. Who are eligible for Medicaid on the basis other than disability. In fact the director of the CM mass says that we have a higher purpose than just handing out Medicaid part. The Medicaid program as promised to help individuals. Live up to their highest potential leading healthier more fulfilling and more independent lives. And joining us on the line is Mike tanner senior fellow with the Cato Institute. Within emphasis on health care and social welfare and social security policy. Welcome to the show Mike we appreciate your time. What blanket pledge should be with you. This has stirred quite a controversy and in fact the in Kentucky won the first two sent their. Policy changes to Washington were approved busing amass and now we're in new federal courts as well as state court from what I understand and here we go again. Right and a lot more I think. Smoke here than fire that this is something people are getting very excited about that going to affect relatively few people. First of all you're dipping the elderly which it the largest cost component a law Medicaid. You're exempting people with disabilities. You're exactly children. Protecting pregnant women. So you really coming down to very small number of people would qualify. For the work requirements and the vast majority of those with 70% are working today. So lose so it's only going to be an ample people that are actually going to fall under the work requirement and make it satisfied not just with war. But sustained is job training going to college but volunteering. Through in communities. So with a variety of ways that can net that they can meet this requirement. It's not going to be nearly all viruses I think on its opponents believe. Yeah I mean there's been reports setting Kentucky alone 97 people lose Medicaid benefits over the next five years at that seems to be. Quite a lot to me but you know when you look at the policy statement in the motivation has seen a massive. I don't understand what the big issue is it says while high quality health care is important for an individual's health and well being. There are many other determinant of health it is widely recognized that education for example. Can lead to improve health by increasing health knowledge. And healthy behaviors. CMS recognizes that a broad range of social economic. And behavioral factors can have a major impact on an individuals help and and wellness. I mean I think. It in and tried to improve somebody's health. And then empowering them. To help with its diabetes or this or that or whatever it may be to get to a more healthy place in life what's wrong with that. Oh absolutely we should recognize that health coverage. Which is what Medicaid is that not the same thing to access the health care and access to health care not the same thing as hell and but our goal in the end should be held. And if we can achieve that main goal through other mechanisms we should. We know for example from studies in Oregon what they've had random assignment study were people region Medicaid or dot. That actually just simply being in Medicaid did not improve health outcomes at all so this might be a way to get justice some better outcomes than what we're currently mean. Yeah and there's a lot of empirical data to support. You know and and evidence that suggests that targeting certain health determinant including productive work and community engagement so it's not just about works it could not able work. They want there's a possibility giving gauging and community programs and helping. You're at the community at large by these programs and ordered it to. To meet dead. A work requirement and also. There's a 2013 Gallup poll that CMS quotes that says. That those would full time jobs currently have are being are being treated for depression left are less twice as less as likely. To not have that when they're gainfully employed. Well that's true that people take a great deal of satisfaction France self identity from having a job. And that that can reflect that help a great deal we know that people get laid off from jobs for example that the significance struck there. And has a lot of impact. There self worth then an old one they're physical health. So we we do think that getting people into jobs lowered least letting them contribute in the communities some ways that they can sort of believe that there are productive members of society is helpful. We should recognize ultimately that Medicaid is they formal welfare. And that combined with a variety of other welfare benefits in ways they can albeit disincentive to works those simply try and all that that to work requirement. It's pretty much common sense. Mine might. You only thing is that I think it's gonna stable lot less money in the governor's belief they'd think there's going to be a lot of people aren't gonna make that you know save them money at a program that's rapidly. Bankrupt interstate and it's not. Well you know the doubles always ended details right in the accountability in in how you we've. These policy decisions in two state government operationally in the management of the Medicaid plan. It can possibly lead to some savings but then again as you point out may not necessarily do so. Which you know in following along which he said earlier and I'll just term it as big news is that seems to be a popular term these days. When you read headlines. It's as if in those seeing MS is absolutely mandating states to do this and that's not really the case. They are they are encouraging demonstration projects amongst the states at the present time correct. Right what they've said that it the state applied for a waiver. In order to implement this work requirement they will look favorably on net waiver and and it will still via an individual basis depending what the state. Which supported the plan. But that whereas it would have been categorically rejected before now they are going to be open to go to. Possibly approving that waiver and it looked like about six or seven states move forward with that right now. And obviously this has become a partisan issue because everybody is pointing out that the only states that have applied for the waiver of those with Republican governors. Well that's right in the certainly has been part of the Republican wish list for a long time yet you work requirements for Medicaid it was actually in. The Medicaid overhaul that was part of the obamacare repeal and replace separate last year. It's something they've been pushing for some time. And the girls applies generally. States that have somewhat smaller Medicaid populations and more budget problems as some of the big states. Yeah. Take a guess at the end of the day the the undercurrent here is all about accountability accountability for one's own place in life and trying to improve that in just not as. The director pointed out that we're just not. In the business of handing out Medicaid carts. Well I mean the ideas waters and our purpose behind anti poverty programs generally whether it's Medicaid or other types of welfare programs. Are we simply trying to prevent people from dying in the streets what we doing reasonably good job of that. But is that enough or should we be trying to help people get out of poverty becomes self sufficient take charge of their lives. And become by the dignity in the I've been I think settling for performers were really selling import short. Yeah and I mean isn't this it we have always had this philosophical argument as to whether or not this is a transitional. Or you know a permanent entitlement. Well it is it is increasingly. A permanent entitlement where people are remaining on the program for long periods of time. Some of that their fault on that the incentive that some of that they've fault with the economy. Which also recognize that even though the majority of people on Medicaid are actually. The the sort of people were accurate welfare recipients. The majority of money spent on Medicaid actually for the elderly in nursing homes sold the little that it is responses state triage their funds that are decide where they want to devote demonic. Yeah I mean there's always this this misnomer. When you refer to this program. About assumptions being made by the general public that it's something that is really not and and really as you point out the vast majority is is spent. On the elderly. And a lot of Medicaid is actually spent in in the realm of mental health as well. Well yes that's right and now of course would addiction treatment for the old Buick this epidemic and so on. We can certainly argue about whether that's money well spent. But but that is word great deal of money going. But you know we took this same attitude as a related to the OP Lloyd and then. And trying to get people clean and move and am back into game being gainfully employed and everything else insane that this is gonna be. A problem as to this overarching philosophy is outline Bessie amass it doesn't seem to make sense that it's kind of that duplicity and thinking of the folks that are opponents to this. Well and I think it's sort of reflective. Argument on behalf of some of the opponents of this that somehow that this statement ties being a poor. Or blaming the poor unity when it actually simply wave. Providing them with the incentives. To take steps that they should be taking it to their own life. There's nothing wrong whatsoever with telling poor people. That if they want assistance they need to contribute someway. Back to society. One of the things at the trop administration is suggesting is that the war. Portion of this Medicaid. A situation that did a line wit. Other. Existing mandates. And and programs such is food stamps and cash welfare programs which generally require. Twenty to thirty hours of work or work related activity every week and to me that just makes sense as well. But certainly would deal with some of the administrative overlap that we one of the problems and while sources and as of total world under different welfare programs seventy some odd. Goes directly to individuals or to other providers to individuals. And they all have different requirements some of work requirement some bill some 120 hours summit thirty hours some. Haven't had college counts some built. So it is very difficult to actually track in and did make his program lineup for the each other. Some sort of the unification would certainly make administrative cents. Well there'll be a lot of the detractors are saying that this will be back a completed minutes straight of nightmare but if we do happen to try and duo work over of a what you just described. That could make it the ease of administration. Better. That certainly would help well part of the problem is but resistant to medications alternate point of service lineups both of them but he. Without insurance and low income walks in to a hospital and you know they cut the rock or something. Both relate. They're going to be treated and thoughtful a sizable but that point. What the previous work history not known and it and probably irrelevant to that point which are not gonna deny care. So that certainly makes makes the problem the second problem that what happened that somebody has the job and get sick and therefore. To lose their job or quit their job because there's six. And then immediately goes in the hospital for treatment at what point are you going to say well. And on days they qualifier cloth like so there's certainly some the missions to be worked out but one reason why these state waivers. Are very important those states are gonna talk about it and deal with the problems that demand. That the federal government leaders say yet that helped organize you were trying Arnold turned it down. Yeah I'm. And in the end no one is saying that Medicaid is not incredibly important to the population that it serves. Well apparently yeah provide coverage for a great many people and it's the only coverage they have. But there's also a bit earlier a great deal that is suggest that it doesn't do much to improve health care outcomes. In many cases being uninsured. It's no big you know worse off than being on Medicaid and we know that that that's an ongoing problem in the program needs to be improved. But it's also bankrupt the states right now it is the largest fastest growing part of the state budgets and it's squeezing out things like education and infrastructure. Public finance to be done about it. Yeah and you know there is a sector of the population that they serve it especially with the physically and mentally disabled it. You're not to name it they're out com is already kind of almost pre determined right it to a certain extent so. You're not gonna move that sector of the population and I think the directors said it well when she said this policy is about. Helping people achieve the American dream. Moving people up a medley of Medicaid is a good outcome because we hope that means they don't need the program anymore. Well that's right and we certainly saw this would work requirements sport and it's that it will be great many people off with tanner. We're seeing that it's an experiment with the food stamp work requirements as well that that instigate people off. It would be a good thing that happens Medicaid as well but again we're talking essentially about able bodied adults who often without children. That that's a relatively small populated percent of the Medicaid population especially in those states that didn't expand Medicaid under the Affordable Care Act. They've database basically still do not have large populations. They're able bodied adults. Absolutely Mike tanner with the Cato Institute thanks so much for joining us who really appreciate your insight and thank you so much for your time.