Medicaid Work Requirements: a Red-Tape Bureaucratic Waste of Taxpayer Money

There is an understandably broad –and bipartisan- appetite to renew Montana’s hugely successful Medicaid expansion program during this year’s legislative session.

Since the program began in 2016, it has brought over 5,000 jobs and more than $240 million in personal annual income to our state.  With labor force participation up 9% among low-income Montanans, we continue to see the ongoing benefits of Medicaid expansion to our economy.

Yet, this question from skeptics is always fair: has Montana’s rollout of Medicaid expansion -long-considered a rare display of successful bipartisanship on a national scale- lived up to what we had all hoped?

It helps to borrow a quote from the Republican who wrote the program.

Senator Ed Buttrey (R – Great Falls) deliberately linked the original program to job training to avoid “a plan that was another entitlement that just had a bunch of people signing up to get free or cheap or subsidized health care.”

In his own words: “We’re going to get you on. We’re going to get you healthy. We’re going to identify your barriers to employment or better employment, and then we’re going to move you off the plan.”

From a conservative starting point, Buttrey’s olive branch to expand Medicaid coverage to 96,000 Montanans – roughly 1/10 of our state’s population- was always meant to be temporary; give the government assistance to Montana families who need it, and only for as long as they need it.

This much is obvious. The question has always been: how do we get insurance to Montanans who can’t afford it without government assistance while making sure that they pursue jobs to someday get them off such assistance?

The fact is, tens of thousands of Montanans are doing both.

In 2017, 57% of Montana businesses had workers enrolled in Montana Medicaid. Over half of these businesses had between 11% and 50% of their employees covered by the program. Seven out of 10 in the Montana Medicaid program are working, and 8 in 10 come from working families.

And of those using Montana Medicaid who aren’t working: over 1 in 3 are ill or disabled.

This is why tying work requirements to Medicaid expansion is, at best, a completely useless waste of taxpayer money.

Only two states have ever passed and implemented work requirements: Kentucky’s have been struck down by the courts, and Arkansas’ are currently under litigation.

But the feeble possibility of work requirements withstanding court challenges in the first place is just one issue. Spending millions of taxpayer money on government surveillance to collect, report and validate exemption status only to cancel, re-screen and re-issue coverage to Montanans using the program is another.

And yes, we are talking millions. Kentucky’s Medicaid administration costs increased by over 40% prior to implementing work requirements- a $35 million price paid by taxpayers only to see the requirements struck down entirely.

The need to deliver a better healthcare system for Montanans’ is a round issue, and work requirements are a square peg that just doesn’t fit.

Implementing work requirements is a one-size-fits all solution that does nothing for Montana’s firefighters, farming, construction, tourism, service and retail workers who often work more than 40 hours per week for several months before being laid off for weeks or months.

In Arkansas, their work requirement program has already kicked 18,000 working people off of health insurance, due to administrative red tape.

Republicans are right to want to continue Medicaid expansion from a market-oriented perspective, but they ignore one fundamental truth. In 2019, you have four basic healthcare options: get it through your employer, pay out of pocket, go uninsured, or sign up for Medicaid.

Montanans aren’t using Medicaid expansion because they’re not working; they’re working and using Medicaid to cover what they can’t pay out of pocket. This isn’t a failure of Montanans to work hard enough for health care; it’s a failure of our system to give them health care they can afford with what their job pays them.

Until insurance and healthcare costs meet wages at a level Montanans can actually afford with what they earn, we must renew Medicaid expansion without work requirements.

So let’s renew and improve Montana Medicaid expansion without the red tape and millions in taxpayer money to implement work requirements. Let’s support –not scrutinize- working Montanans struggling to afford healthcare, and let’s continue to identify barriers to their employment opportunities while growing jobs and our economy.

When Buttrey and other Republicans say that now is the time to “move you off the plan,” they’re dead wrong.

If you appreciate an independent voice holding Montana politicians accountable and informing voters, and you can throw a few dollars a month our way, we would certainly appreciate it.

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Nathan Kosted


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  • I have represented people in SS disability hearings for 30 years. Every year some of my clients would die from their illnesses. In 2016 and later I haven’t lost a single client because they were able to get on medicaid before they got on SSA disability. For most of my clients that process takes between 2 and 3 years. It’s not hyperbole to say that this program saves lives and it should be continued.

  • Most people would rather have a job then ask for assistance. Pride is a value that comes from earning your own way. The cost of health care is way out of proportion to the average taxpayers wages.

    It makes complete sense to provide preventive medicine so that folks can get back on track. A healthy citizen is a happy citizen who will be eager to earn their own way.

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