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austerity
Here's Why We Know Work Requirements for Medicaid Don't Work
And let's not forget how cruel they are.
Dec 21, 2024
As Republicans at the federal level prepare to take over majorities in both the House and Senate, some have proposed deeply damaging cuts to Medicaid, including taking health coverage away from people who don’t meet unnecessary and burdensome work requirements. Some state policymakers are interested in pursuing Medicaid work requirements as well. But a Georgia Medicaid program provides the latest evidence that work requirements are the worst sort of red tape — blocking health coverage for working people, people with serious health conditions, and people with disabilities.
Georgia is one of ten states that has not adopted the Affordable Care Act’s Medicaid expansion provision, instead applying for a waiver to provide Medicaid to certain low-income adults, conditioned on meeting work requirements. This waiver program, called Pathways to Coverage, requires adults with low incomes to report at least 80 hours of work or volunteer activities each month as a condition of getting and keeping their coverage. It is available to adults up to 100 percent of poverty, or $15,060 annually for an individual.
The results from over one year of Pathways to Coverage are in:
- About 5,500 people were covered as of November 2024, far less than the 110,000 who initially expressed interest, and well under the about 240,000 uninsured people estimated to potentially be eligible for Pathways.
- Application backlogs, excessive paperwork, and complex rules have left people waiting for coverage after they’ve applied and kept many other people from even applying for the program.
- Spending on administrative changes, such as systems updates, eclipsed spending on health care services and offered little return on investment in facilitating enrollment.
Work requirements prevent people from accessing health care for reasons that are outside their control. For example, many people working low-paying jobs are at the mercy of employers who can reduce their hours without notice. Family emergencies, inconsistent childcare, or sudden illnesses can also disrupt a person’s ability to work. Furthermore, people with disabilities and chronic illnesses are not exempt from the Pathways reporting requirements. They could face challenges finding enough hours to work because employers will not provide reasonable accommodations or their health conditions restrict the amount of time they can work. As a result, people are at risk of not receiving often life-saving health coverage.
Previous work requirement proposals conditioned continuing Medicaid coverage on reporting enough eligible work, or other qualifying activity, hours. Georgia’s Pathways program adds an additional hurdle: requiring work reporting at the time of application, which creates a complex process that deters eligible people from even applying. In June 2024, 42 percent of the people who expressed interest in applying for Pathways were not considered to have a complete application because they did not complete a report showing any number of qualifying activity hours. And among those who did have complete applications, 19 percent were denied due to reporting fewer than the required 80 hours per month or insufficient verification of hours.
Focus groups conducted by Georgia Budget and Policy Institute and Creative Research Solutions back up this data. Pathways applicants pointed to challenges getting support during the enrollment process, technology issues with the enrollment system, or frustrations with getting denied due to paperwork issues and having to wait to have the application checked again.
Georgia is among the slowest states to process Medicaid applications due to excessive bureaucratic strain. Others didn’t feel comfortable applying because they were concerned they would not get approved, likely due to the complex process and the high denial rate in the first year. The frustration with paperwork issues and the stress from not having health coverage are similar to findings from focus groups in Arkansas, the first state to implement a Medicaid work requirement temporarily in 2018.
And although only a small fraction of eligible people have enrolled, the program has cost about $13,360 per enrollee in combined state and federal Medicaid spending through the end of the first year. That’s significantly more than the about $2,490 per enrollee Pathways was initially estimated to cost in the first year. About 35 percent of spending went toward covering care, but most went to systems modifications to implement work reporting. And in August 2024, the state separately spent $10.7 million on an outreach campaign, directing millions to consultants while hundreds of thousands of people are still without insurance.
From the standpoint of ensuring access to health care and improving efficiency, it is clear from Georgia that work requirements do neither. Once again, the Pathways program shows us that work requirements are simply a way to keep people from getting health care by requiring them to navigate a complicated system to report work hours or claim exemptions. This is especially cruel because the few people who made it through the process and secured Medicaid coverage through Pathways reported being able to get lifesaving care, medications, and other health tools to manage or prevent long-term illnesses.
Even though Georgia sought to use this program as an alternative to expanding Medicaid, the same lessons would apply in states that already expanded coverage. Policymakers should reject work requirements, which leave people with higher health care costs and state agencies with increased burden.
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Call for $2.5 Trillion in Cuts Proves GOP Wants to 'Steal Our Benefits'
"Nearly 60% of mandatory spending is for Medicare and Social Security," noted one expert. "If they don't touch those, they'd have to cut Medicaid to the bone."
Dec 20, 2024
With a potential government shutdown just hours away, House Republican leaders displayed a slide during a closed-door GOP conference meeting on Friday showing a draft agreement proposing $2.5 trillion in net mandatory spending cuts in exchange for raising the U.S. debt ceiling by $1.5 trillion at some point next year.
The slide was seen as further confirmation that Republicans are seriously eyeing cuts to Social Security, Medicare, Medicaid, and federal nutrition assistance—programs that fall under the mandatory spending category.
Though by law Social Security cannot be cut in the reconciliation process that Republicans are planning to use to bypass the Senate filibuster and Democratic opposition in the upcoming Congress, other key programs including Medicare and Medicaid could be vulnerable to the GOP's massive proposed austerity spree.
"The ONLY WAY to cut $2.5 trillion in spending is by slashing Social Security, Medicare, and/or Medicaid," the progressive advocacy group Social Security Works (SSW) wrote on social media in response to the slide. "Republicans want to steal our benefits to pay for their billionaire tax cuts."
Bharat Ramamurti, former deputy director of the White House National Economic Council, wrote that the slide "is a Republican commitment to cut Medicare, Social Security, or veterans' benefits (all to make way for new tax cuts for the rich)."
"There's no way to make this math work otherwise," he added. "Their promise is to cut $2.5 trillion in mandatory spending. Nearly 60% of mandatory spending is for Medicare and Social Security. If they don't touch those, they'd have to cut Medicaid to the bone."
Sen. Elizabeth Warren (D-Mass.) warned that the draft agreement means "Republicans are plotting to cut healthcare for seniors and veterans to grease the wheels for tax cuts for giant corporations and billionaires like Elon Musk."
For weeks, Republicans have been discussing potential cuts and sweeping changes to Medicaid and the Supplemental Nutrition Assistance Program (SNAP)—including the addition of new work requirements—to help pay for a fresh round of tax cuts that would largely benefit the richest Americans and large corporations.
Republicans working with Musk and Vivek Ramaswamy—the billionaire co-chairs of the soon-to-be-created Department of Government Efficiency—have also signaled that Social Security and Medicare cuts are on the table even after President-elect Donald Trump campaigned on protecting the programs.
"Republicans have made their plan for the new year crystal clear: Ram through massive tax giveaways for the ultra-wealthy and corporations, and pay for them by shaking down programs and agencies that working families rely on," Groundwork Collaborative executive director Lindsay Owens wrote in a Rolling Stoneop-ed on Friday. "And they're putting unelected and unaccountable oligarchs—Musk and Ramaswamy—in charge of deciding how much pain Americans will have to tolerate so that the rich can get richer."
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Dems Rip Musk-Ramaswamy Plan for Spending Cuts as Illegal 'Power Grab'
"The legal theories being pushed by Elon Musk and Vivek Ramaswamy are as idiotic as they are dangerous," said the top Democrat on the House Budget Committee.
Nov 22, 2024
Democrats on the House Budget Committee said Friday that the plan Elon Musk and Vivek Ramaswamy outlined to eliminate spending already appropriated by the U.S. Congress would run afoul of a federal law enacted in response to former President Richard Nixon's impoundment of funds for programs he opposed.
In a Wall Street Journalop-ed published earlier this week, Musk and Ramaswamy specifically mentioned the 1974 Congressional Budget and Impoundment Control Act (ICA) only to wave it away, arguing it would not hinder their effort to enact sweeping spending cuts as part of the "government efficiency" commission President-elect Donald Trump appointed them to lead.
But House Budget Committee Democrats said Friday that the Nixon-era law and subsequent Supreme Court rulings make clear that "the power of the purse rests solely with Congress."
"Fifty years after the ICA became law, Congress once again confronts a threat attempting to push past the long-recognized boundaries of executive budgetary power," the lawmakers wrote in a fact sheet. "During his first administration, President Trump illegally impounded crucial security assistance funding for Ukraine in an effort to benefit his reelection campaign. Now, Donald Trump and his far-right extremist allies are pushing dangerous legal theories to dismantle that system."
"They want to give the president unchecked power to slash funding for programs like food assistance, public education, healthcare, and federal law enforcement—all without congressional approval," the Democrats continued. "American families would be forced to pay more for basic necessities, investment in infrastructure and jobs would decline, and our communities would become less safe. Instead of working within the democratic process, Trump and his allies want to sidestep Congress entirely. But the Constitution is clear: only Congress, elected by the people, controls how taxpayer dollars are spent."
"House Democrats are ready to fight back against any illegal attempt to gut the programs that keep American families safe and help them make ends meet."
The fact sheet was released days after Musk and Ramaswamy, both billionaires, offered for the first time a detailed explanation of their plan to pursue large-scale cuts to federal regulations and spending, as well as mass firings of federal employees, in their role as co-heads of the Department of Government Efficiency (DOGE).
The pair noted that Trump "has previously suggested" the ICA is unconstitutional and expressed the view that "the current Supreme Court would likely side with him on this question." The former president appointed half of the court's right-wing supermajority.
"But even without relying on that view, DOGE will help end federal overspending by taking aim at the $500 billion-plus in annual federal expenditures that are unauthorized by Congress or being used in ways that Congress never intended, from $535 million a year to the Corporation for Public Broadcasting and $1.5 billion for grants to international organizations to nearly $300 million to progressive groups like Planned Parenthood."
Other programs that would be vulnerable if Musk, Ramaswamy, Trump, and Rep. Marjorie Taylor Greene (R-Ga.)—who's set to lead a new related House subcommittee—get their way are veterans' healthcare, Head Start, housing assistance, and childcare aid, according toThe Washington Post.
Rep. Brendan Boyle (D-Pa.), the top Democrat on the House Budget Committee, said in a statement Friday that "the legal theories being pushed by Elon Musk and Vivek Ramaswamy are as idiotic as they are dangerous."
"Unilaterally slashing funds that have been lawfully appropriated by the people's elected representatives in Congress would be a devastating power grab that undermines our economy and puts families and communities at risk," said Boyle. "House Democrats are ready to fight back against any illegal attempt to gut the programs that keep American families safe and help them make ends meet."
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