Democracy Dies in Darkness


Arkansas’s Medicaid experiment has proved disastrous

November 19, 2018 at 7:06 PM

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Columnist Catherine Rampell reports for PBS NewsHour on a major initiative of the Trump administration that has been adding work requirements to benefit programs for the poor, now including Medicaid. This year, Arkansas became the first state to roll out the requirement. As a result, more than 12,000 people there have lost their coverage. (PBS NewsHour)


This summer, Arkansas became the first state to require poor people to prove they’re employed to receive Medicaid.

Critics say the state is trying to save money on the backs of the poor. That’s nonsense, Arkansas officials reply. They want to help  the poor. Backed by the Trump administration, they are inspiring slackers and moochers to climb the economic ladder.

Thirteen other states are pursuing similar policies. They’d do well to pause their plans. For many low-income families, the Arkansas experiment has already proved disastrous. More than 12,000 have been purged from the state Medicaid rolls since September — and not necessarily because they’re actually failing to work 80 hours a month, as the state requires.

Consider Adrian McGonigal, who is challenging the policy in federal court.

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The Trump administration is calling Medicaid work requirements a positive "incentive" for beneficiaries, but critics warn that they're a harmful double standard that could be illegal. (Jenny Starrs/The Washington Post)

McGonigal, like most non-disabled, nonelderly Medicaid recipients, had a job. Full time, too, at a chicken plant. The plant’s chemicals sometimes aggravated his COPD, a chronic lung disease, but his employer accommodated the condition by moving him from processing to shipping.

More important, McGonigal’s prescription medication — funded by the state’s Medicaid expansion, since his job didn’t come with health insurance — kept his symptoms in check.

McGonigal was unclear about what he needed to do to report his work hours, or if he had to report at all. The new policy applies only to Medicaid expansion enrollees, but even most people in that group don’t have to frequently check in with the state (because of age, disability, state already has work information on file, etc.). Like many I spoke with, McGonigal says he got confusing and sometimes conflicting information from the state’s Department of Human Services, which told him to report online. He doesn’t have a cellphone or computer, so he borrowed his sister-in-law’s smartphone.

“I thought that everything was good,” he told me in an interview for The Post and “PBS NewsHour.” “I thought it was just a one-time deal that you reported it, and then that was it.”

It wasn’t. 

The state wanted him to report  monthly . He learned this only when his pharmacy told him his insurance had been canceled. After that, he couldn’t afford his medication. His COPD flared up and he landed in the emergency room. And he missed lots of work.

“I tried to stick it out, and still go to work, but I just couldn’t do it,” he said. Ultimately, reluctantly, his supervisor let him go.

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Opinion writers Charles Lane, Molly Roberts, Jennifer Rubin and Dana Milbank debate the Trump administration's plan to make low-income Americans work for their Medicaid in this clip from the weekly news roundup, "It's Only Thursday." (The Washington Post)

In other words: A policy intended to help people get jobs instead cost McGonigal his. 

This was predictable. A Hamilton Project report found that the preponderance of evidence suggests Medicaid has little or positive effects on labor-force supply. For many families, safety-net services support work, rather than discourage it.

There are other reasons programs such as Arkansas’s are unlikely to improve work outcomes. 

The lives of low-income Americans can be precarious. They may change addresses and phone numbers often — which explains why other Arkansans I interviewed, including at a Little Rock homeless shelter, said they learned about the work reporting system only after their insurance was already at risk.

Arkansas’s overall unemployment rate is low. But in rural areas, jobs still can be few and far between. Many workers don’t have control over their hours, either.

Consider another plaintiff, Anna Book, who is homeless. A restaurant dishwasher, Book just barely meets the state’s 80-hour monthly minimum. But if business is light, she might lose a shift.

She has already fallen below the threshold once; after three strikes, she’ll be barred from Medicaid until the following January.

Medicaid recipients can’t directly report over the phone, in person or by mail. Like McGonigal, Book doesn’t have a computer. She designated a pastor to log her work hours for her.

The state made reporting online-only to avoid hiring more staff. (It also didn’t allocate any additional dollars to help enrollees find work.) Officials did this even though Arkansas has the lowest level of household Internet access in the country, and the online portal doesn’t work well on smartphones. Once, when I tried it, I got an error message saying my phone’s browser was “not compatible.” The next day, it was mysteriously compatible again. 

Most indefensibly, the website shuts down every single night  between 9 p.m. and 7 a.m. for “scheduled maintenance.” 

No wonder 80 percent of those required to report work hours or exemptions each month are reporting nothing at all. 

I asked Cindy Gillespie, director of the state’s DHS, how confident she was that all — or even most — of the thousands of people kicked off Medicaid were not working and were insufficiently motivated to work. She said she’s confident anyone improperly removed from the rolls could easily get their situation reversed.

McGonigal’s experience suggests otherwise.

Last month, his legal-aid lawyers persuaded DHS to grant him a “good cause” exemption and a chance to re-enroll in Medicaid. But because of additional red tape, he still hasn’t gotten any of his medication. It’s been six weeks. 

Meanwhile, the chicken plant says he’s welcome back. But only, McGonigal says, when — and if — he’s healthy enough to work.

Read more:

Ron Haskins: Trump’s work requirements have been tested before. They succeeded.

The Post’s View: Work requirements won’t solve hunger and sickness

Christine Emba: The GOP is quietly crafting work requirement waivers — for white people

The Post’s View: Medicaid work requirements are a solution in search of a problem

Catherine Rampell is an opinion columnist at The Washington Post. She frequently covers economics, public policy, politics and culture, with a special emphasis on data-driven journalism. Before joining The Post, she wrote about economics and theater for the New York Times.

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