I am sure you’ve all heard that Kentucky was granted permission to require Medicaid recipients to get a job.  I am even sure many of you think this is a fine idea.  After all, why should an able-bodied person get to flounder at home and use our tax dollars to garner a benefit.

Except…

There’s way more to this concept than what meets the eye.  The first goal is to create impediments to folks obtaining Medicaid.  With the hope that many recipients will simply walk away from the benefit they need rather than complete the forms- which are not simply a one-page, fill in a few boxes, deal.

Does anyone consider the fact that many of these potential  recipients may not be able to comprehend the questions, read fluently, or to be addled on drugs to pass the test- i.e., fill out the necessary paperwork.  You can bet those advocating for these new “literacy tests” are fully cognizant of what will occur.

Placing impediments for those obtaining Medicaid is not a new concept for conservatives.  They’ve been aching to throw a monkey wrench into the system for 53 years now.  Over these 5+ decades, the program has grown to provide insurance for 72 million low-income Americans.  That comprises those folks who are in the lowest 25% of all households in the US, and the costs for Medicaid are about $ 586 billion a year, or 1/6 (17%) of the total US health care costs.

By the way, this concept- having Americans believe that able-bodied folks were deliberately shirking work- was tried before.  Under Bill Clinton, a “welfare reform” bill (Temporary Assistance to Needy Families or TANF) was passed by the GOP Congress that added work requirements to welfare (not to Medicaid).   And, those requirements managed to get folks involved in community service, volunteering,  or some training for two years- which change evaporated by the fifth year. (Because the training led to no jobs, the community service and volunteering provided no local or state benefit were among the primary reasons.) Moreover, as opposed to TANF, Medicaid doesn’t give folks money to buy food or pay rent (or, as the GOP wants you to believe, to dribble away on drugs, candy, or alcohol- and they never mention the lottery scams they run, because the states make money off these).  No, Medicaid only pays doctors, hospitals, nursing homes, and clinics.

Kentucky feels they will lower the Medicaid enrollment by 95000 folks- and claims this process will save $ 2.4 billion over a five year period.  That will account for about 7% of the 1.3 million folks covered by Medicaid right now- and Medicaid is provided to some ¼ of the state’s residents.

There’s also this.  Kentucky plans to impose a premium of 4% of the recipient’s income.

We all agree that getting folks to work if they can is a fantastic concept.  But, getting folks to work doesn’t mean they are not entitled to Medicaid.  Just look at the bar chart above.  And, we’ve discussed how we citizens are subsidizing McDonalds, WalMart, and a bunch of big firms that claim they are profitable by paying their employees just enough to surpass minimum wage, but who still need supplementation with Medicaid and AFDC (aid for dependent children) and Food Stamps (SNAP, supplemental nutritional aid program).   That will certainly be true for Kentucky’s lucky 95,000 people who may find jobs.

But, it’s more than just this factor. We need to consider some dirty little secrets that most of you don’t know.  One of the biggest problems states had before the implementation of PPACA (Patient Protection and Affordable Care Act, aka Obamacare) was covering the hospital bills for those folks who were treated and had no insurance.  That expenditure is called “uncompensated care”.

As folks get covered by Medicaid (and other insurances) two facts occur.  The first one is obvious.  When those folks need to be treated in a hospital, they have insurance.  So, the facilities are not uncompensated, and the state is not going to have to bail out those hospitals for as much “unpaid” bills.

Moreover, once folks are covered by insurance- be it conventional insurance or Medicaid (or Medicare)- they have joined a “buying club”.  The coverage they have involves the entity providing insurance setting the fees that can be charged for various treatments.  And, those fees are generally lower- MUCH lower- than those imposed when someone has no insurance.  So, the health care costs actually drop by some percentage.

And, here are some vital numbers for Kentucky.

It’s pretty clear that Kentucky’s costs have certainly increased as it has expanded the number of folks covered by Medicaid.  And, Medicaid costs are a significant portion of Kentucky’s budget.  But, what you don’t see is that about 2/3 of the costs involved in the Medicaid program are for long-term care needs- nursing homes,  in-home aging or care services, and the like.  It’s pretty clear that those receiving these services are not going to be able to work.  (Now, you begin to understand why only 95,000 recipients form the entire pool of  the “getting folks to work” focus.)

And, for the pièce de résistance.  As Kentucky expanded its Medicaid program, the amount of money involved in uncompensated care has dropped from $ 2.4 billion dollars in 2011 to about $ 522,000 in 2015 and 2016. So, the overall cost for Medicaid and health care expenditures for Kentucky has not really grown the way the chart would imply.  (Note:  A significant portion of uncompensated care costs are paid for by the state and localities- because without it, many hospitals would fold.)

And, it’s not just Kentucky that’s playing with people’s lives.  Indiana is also introducing work requirements- and imposing a surtax (50%) on premiums for anyone who is a tobacco user. Which will exceed the guidelines for Medicaid premiums by at least 2%. Oh, and Indiana also is considering a premium of $ 1 to $15 to cover dental and vision care- or maybe just require co-pays for basis services and never cover dental or vision. That’s despite the Federal law that stipulates that NO premiums are to be paid by anyone earning under 150% of the poverty line, or by anyone earning $ 17,999 or less.

North Carolina wants to put a different set of monkey-wrenches into the mix, if it allows a Medicaid expansion.  It plans to disallow insurance from anyone who is more than 61 days late paying the premium. Maine one-ups North Carolina with its plans to lock out all those who fall behind in their premiums for 90 days after they fall behind- even if these folks are below the poverty line.

Maine has submitted a waiver to impose mandatory payments on those earning as little as $6,000 annually with no proposed corresponding increase in coverage, as well as new premiums for a health-care program that poor parents can use while leaving welfare programs to join the workforce.

And, Wisconsin wants to play, too.  Wisconsin will require drug testing (why don’t we also test the legislators, who seem to be smoking something…).

So much for the bogeyman (or bogeywoman) who is lounging around collecting Medicaid.

How about leaning on those profitable employers underpaying their staff- and having you and me pay OUR money for supplementing their food or being covered by Medicaid in the first place?

Nope.  Those guys donate to the campaigns of the Kentucky, Indiana, Wisconsin governors.  Medicaid recipients don’t.