Proposed federal work requirements for Medicaid recipients could impact up to 44,000 West Virginians. An analysis of the proposed policy found recipients could lose coverage if these new policies become law. Those recipients are working, but complicated reporting procedures may make it harder to get the coverage they’re qualified for.
Health reporter Emily Rice spoke with healthcare policy expert Katherine Hempstead, senior policy adviser for the Robert Wood Johnson Foundation, about the potential impact in West Virginia, where one in three residents relies on Medicaid.
The transcript below has been lightly edited for clarity.
Rice: So I would just like to hear from a researcher and a policy analyst, expert, what is going on on a federal level, What is changing, and what does that mean for the everyday person that depends on Medicaid?
Hempstead: At the federal level, there’s kind of a hunt for dollars, you know., There’san intense demand for Republicans in Congress to find ways to cut spending, to finance tax cuts, and in the effort to look for places where the budget can be cut, the Medicaid program has been identified as kind of a potential target, because it’s a large item. It’s about $600 billion a year in federal spending. And the Medicare program had been sort of previously declared off limits by the President. Medicaid emerged as sort of this opportunity to make cuts. The vast majority of people that are eligible for Medicaid through the expansion population came through from the [Affordable Care Act]. And in West Virginia, that’s more than 150,000 people. Like it’s a lot of people.Nine out of 10 of those folks are either working or they’re doing some other exempt activity, like caregiving for a family member or looking for work, or they have some kind of physical or mental health problem that prevents them from work. So, you know, if you think about that, then you would say, ‘Well, why would you bother having work requirements?’ Because you’re not going to really, save a lot of federal money, right? If everybody’s working. But what we’ve seen from other states that have tried to do work requirements is that so many people have trouble successfully complying with the requirements to report their activities, that a lot of people lose coverage, even though they are really still eligible for Medicaid.
Rice: It’s interesting, because that has been such a huge topic in West Virginia. We have, I believe, still, the lowest workforce participation rate in the nation. So I wanted to talk a little bit more about people like you were talking about, that may work for cash, that they have to work multiple jobs because they may be taking care of a family member, or something like that.
Hempstead: And that’s how we found a lot of people lost coverage, because they were doing compliant activities, but they weren’t successful in communicating that to the state. And I feel like in a state like West Virginia, you would see a lot of that.
Rice: The rural aspect of our state really plays against us, because when we had pandemic era, unrolling of those benefits, we had a lot of problems with people. You know, there’s a lot of people that only have a cell phone. They don’t even have a computer, they don’t have access to a WiFi connection. They just have a pay-by-month phone. And so they’re trying to do all of this paperwork on, you know, a tiny cell phone screen. And it’s extremely cumbersome, it’s so easy to make a mistake. Is this a similar situation to that?
Hempstead: I am so glad you brought that up. I mean, I always like to ask reporters if they had any experience covering that, and that’s exactly the kinds of barriers that people will have complying with these work requirements. That’s exactly right, and that’s why so many people will lose their coverage. And then, as you know, it’s very hard to get your coverage back, even when you’re eligible.
Rice: I think you mentioned that you’ve spoken with some people who may have voted in favor of some of these policies and not understood entirely the implications of them. Are those same people coming to experts like you now and asking questions?
Hempstead: Yeah, I’m glad you brought that up, because among real people, like regular people, our polling has found that partisan polarization around coverage stuff is really declined. And if you look at, you know, likeability or approval of Medicaid or of the affordable care act like we’re seeing, that the differences between Republicans and Democrats are narrowing significantly.
And some of that is definitely because of a kind of realignment, so that more people in the Republican Party are lower income and are much more likely to use these programs themselves or have relatives that do, and just the kind of experience of the pandemic and just the overall growth inboth of those programs, they’re very, very important in a lot of red states and in a lot of rural areas. So the average person isn’t obsessed with waste, fraud and abuse. The average person doesn’t want to cut Medicaid, thinks Medicaid is important, thinks people need healthcare.
It’s really just this quest for cuts that’s really motivated by a charge from from on high to make these very regressive tax cuts permanent, that is making people look for places that they can cut. And unfortunately, you know, Medicaid is seen as kind of a soft target. But I think when you talk to real people, you find a lot of support for Medicaid and an understanding of the value of what it does for the expansion population, for moms and kids and also for the elderly and disabled.
