Michigan’s Pending Work Requirements For Medicaid
A little over a week ago, the Michigan Senate passed SB 897 which calls for the most draconian work requirements in the nation to be inserted as a requirement into our version of the Medicaid Expansion or, as we call it, the Healthy Michigan Plan.
Full disclosure, the Medicaid expansion arguably saved my life.
As a formerly incarcerated Michigander (and registered citizen) who has struggled at times starting my own writing business, I know there is no way that I could have afforded surgery last year or to pay for a follow-up emergency procedure that became necessary due to complications.
This is personal, but it is not only about me.
SB 897 is one of the most unnecessary, cruel, intentionally destructive, and counterproductive pieces of legislation I have ever seen (and I have been involved in public policy research since the early 1980's).
Senate Bill 897 Is Unnecessary
Like a brutal hammer seeking out the most vulnerable nail, SB897 requires that every Healthy Michigan recipient (with few exceptions) provide evidence that they work 29 hours-a-week to the Michigan Department of Human Services. If a Medicaid recipient were to fail to prove compliance, they would be ejected from coverage and prevented from reapplying for an entire calendar year.
But why? Is there a problem needing to be fixed?
A few years ago the University of Michigan conducted a study, published in the New England Journal of Medicine, that suggested rather than being problematic, instead, the creation of the Healthy Michigan Plan had created massive economic and employment benefits for the state.
And it makes sense, if you are healthier, you are more able to work. When you get sick, even with a job, health care helps you get back to work more quickly.
This was certainly true in Michigan, as Emily Schwarzkopf of the Michigan League for Public Policy explained recently:
“Right here in Michigan we have data showing that Medicaid enrollees are working and that their ability to have health insurance improves their work outcomes. A study by the University of Michigan shows that of those enrolled in Michigan’s Medicaid expansion program, Healthy Michigan, 69% did better at work once they were covered, and that those who were out of work said that coverage made it easier for them to seek out a job.”
So, most of the targets of this bill are already working, and still poor. Let that sink in for a second…Okay, so, what is the real reason for this bill?
Senate Bill 897 Is NOT About Alleviating Dependency
We have seen this play before.
In the mid-90’s, the push began to reform the social safety net to move “able-bodied” people from welfare to work. The end result was a changed social safety net program, requiring work for benefits, referred to as TANF and the results have been anything but impressive. To import TANF ideas into new social safety net legislation would be like asking for advice on how to run your town from the former Flint Emergency Manager.
So why is Michigan’s GOP majority doing this? Here was Bill Sponsor, Senator Shirkey’s Response:
“The best safety net ever invented by God is family. I’m not sure that government is supposed to supplement that process.”
Sanford Schram and Joe Soss make sense of the trend in GOP thought by defining it in more ideological terms:
“With all we know about poverty and public policy, what could these legislators possibly hope to accomplish? Do they just hate the poor?… Many liberals respond to the draconian new laws as if they were just the latest right-wing outrage of the day…It’s fair enough to say that the new welfare restrictions are unwarranted and cruel. But we should not confuse such criticisms with a political analysis of why such policies are pursued, whom they benefit and harm, and how they matter for power and position in the American political economy. Whatever may be going on in the hearts and minds of particular legislators, the paternalistic welfare rules being debated across the states today are far from novel and, in fact, far from irrational. They are new variants of old practices that work to shore up work compliance, service business interests, impose moral programs on the poor, and strengthen broader political alliances and agendas.”
So what is it really all about?
Is it possible that the political interests involved aren’t really as opposed to dependency as they are in ensuring dependency generates money for their own interests? Schram (A Professor of Political Science) and Soss continue:
“As the state has been marketized, its welfare operations have been redesigned to generate profitable sites for corporate investment and services for employers. Thus, even as welfare programs have continued to serve low-wage labor markets by excluding and expelling people in need, they have also become their own markets for “spinning the poor into gold.” Today, private welfare contractors — like their counterparts in the private prison industry — run their agencies as businesses undertaken to generate profits, and in welfare programs around the nation, a wide assortment of other market interests gather at the banks of the budgetary stream, hoping to turn social needs into revenue.”
Sound farfetched? Here is what the Michigan Chamber of Commerce had to say about SB 897 (in a piece called, “Senate Passes Commonsense Medicaid Work Requirement; Chamber Encouraging Swift Action by House.”):
“ Michigan is currently experiencing a workforce shortage and talent gap. Estimates suggest that as many as 100,000 jobs are currently unfilled. The Chamber believes Medicaid work requirements, modeled after what has been required under the Unemployment Insurance system since the 1930s, could help employers with their labor shortages.”
The language might be different, but the reasoning sounds pretty similar.
Oh, and did I mention that the “work requirements bill” includes ZERO funding for employment training, training in soft-skills, or assistance in helping Medicaid recipients find employment?
And here is where we get to the cruelty.
SB 897 Is Purposefully Cruel
As many as ONE MILLION people would be affected by this change.
Every single one of them would be at constant risk of losing their health care (remember if you can’t prove — even one time — that you worked the correct amount of hours, you would lose your coverage and could not reapply for one year.
In fact, even if you met the per-week requirement in the aggregate, if you did not work 29 hours in any particular week you would be SOL for a year.
When the Michigan Chamber of Commerce mentions that there are lots of jobs open, what they don’t mention is the kind of job opportunities available.
In most cases, the jobs available are service jobs which are exactly the kind of variable and even seasonal jobs where hours get changed a lot and people are laid off causing Jesse Cross-Call to claim:
“Counterintuitively, many of those losing coverage would likely be workers. Most Michigan Medicaid enrollees who would be subject to the new policy already work, but often in unstable jobs with fluctuating hours, in industries like retail, restaurant work, home health, or construction or in seasonal jobs such as in the state’s tourism industry. Nationally, we estimate that even among low-income workers who would meet Michigan’s proposed 29-hour-per-week work requirement on average over the course of a year, 25 percent would be at risk of losing coverage because they don’t meet the requirement every month.”
And anyone who has ever spent any time at a DHS office knows that the forms make even well-educated folks shudder, the computers you apply on are notoriously buggy, and you rarely if ever get any confirmation of the status of your account until it is already too late. Considering that many of the folks who will have to come to grips with this new system are dealing with health and/or mental health issues, this seems like a recipe for health care disaster.
And let’s not forget that most of these “available jobs” don’t come with employee health benefits. It is also important that I mention that a very large number of formerly incarcerated people are recipients of Healthy Michigan’s health care. Formerly incarcerated people often can’t find work not because of laziness, but because companies will not hire them (I came out of prison with a Master’s Degree and couldn’t get a job bussing tables).
Many poor folks (and especially formerly incarcerated poor folks) try to start their own businesses in order to do the work they are best suited to do in an economy that actively discriminates against them. Per Hour Work Requirements almost always require a pay stub or receipts for paid work. Unfortunately, as almost anyone has started a business knows (and I have), you don’t get receipts for sweat equity and you rarely get equalized pay from week to week.
And let’s not forget all of the people who could be left behind entirely:
- Opioid or other addicts, who are struggling to stay alive much less recover
- People struggling with mental health issues and struggle to stay employed
- People stuck in violent relationships or with unstable child care situations
- People fired or laid-off who just can’t find a new job in time to meet the draconian weekly hour requirements
- Seasonal workers, like construction workers
<Apologies, I am sure I am leaving out many other obvious examples of folks who would be hurt immediately by this legislation>
Just to make this point really clear. The only drug addiction exception in SB 897 is for people who have been court-ordered or medically prescribed treatment that would interfere with work. So, if an opiate addict, for instance, had a relapse, and were not able to work as a result they would lose coverage for at least a year.
Let me repeat, at the moment of crisis, when they need medical intervention the most, they could be without health care.
But, okay, let’s say you were to somehow navigate all of these obstacles successfully, clock your 29 hours a week, navigate the bureaucracy correctly but never find a better job?
Would you get congratulated, get super-healthy Michigan benefits?
Nope, after 48 months, SB 897, would kick you out of the program (the bill includes a mandatory cap).
This bill is just 100% cruel.
So, to recap:
- Most of the people on Healthy Michigan already work
- Healthy Michigan helps folks find and keep jobs
- SB 897 would make a million, mostly working people, constantly at risk of losing their health insurance unless they can correctly navigate a byzantine bureaucracy
- If you, somehow against all odds, navigate the bureaucracy correctly, you will lose your ability to qualify for health insurance in four years.
Don’t worry, it gets worse.
SB 897 Is Counterproductive
So, the rotten cherry on this putrid cake is that SB 897 would likely decrease employment and new employment. Don’t just take my word for it, ask the experts:
“Are work requirements actually necessary to encourage Medicaid beneficiaries to get and keep jobs? National estimates indicate that almost 80 percent of “able-bodied” non-elderly adults with Medicaid are in working families and 60 percent are working themselves. University of Michigan researchers at the Institute for Healthcare Policy and Innovation have found that most adults covered under Healthy Michigan are already working or in school. And both studies suggest that those who aren’t working have major barriers to employment, including chronic health conditions, physical or mental health problems, or full-time caregiving responsibilities. For example, among Healthy Michigan enrollees who were out of work, one third were in poor health and three quarters reported a chronic health condition. Randomized controlled trials, gold standard studies that use test and control groups to precisely measure the impact of a program, show that insurance coverage may actually be more effective than work requirements in helping families get and keep work. One such experiment found that Medicaid coverage reduced depression — a major barrier to employment — by almost 50 percent (though the jury is still out on whether physical health improved). Another, the RAND Health Insurance Experiment, found that less-educated people in free healthcare insurance plans were more likely to increase their participation in the labor force.”
Many of the proponents will try to sell you on the idea that the point is to decrease state budgetary costs but the costs of administering the work requirements would be massive and would create huge costs for hospitals and healthcare systems that had been alleviated by the Medicaid Expansion.
It doesn’t help anyone get work, keep health insurance, or save the State money.
SB 897 is an unnecessary, cruel, intentionally destructive, and counterproductive Bill. If it reaches Governor Snyder’s desk he should veto it in every form. There is no “Good” version of this bill that should be passed. Work requirements don’t magically start helping people when you reduce their duration.
Enough already, please call your representatives and Governor Snyder and demand that they oppose this terrible legislative idea.
Medicaid Workfare: Ideological Cruelty Masquerading as Good Public Policy
The President’s Cruel Workfare Guidance on Medicaid
Josh is the co-host of the Decarceration Nation podcast, a blogger, and a freelance writer. Please consider following him on Twitter, throwing a tip into his hat on Patreon, showing your appreciation using Paypal.me, or adding OnPirateSatellite to your feeds.