WASHINGTON — An estimated 14,000 Alaskans, and millions of Americans, would lose their health insurance from one feature of the Republican budget reconciliation bill now pending in Congress.
That element is a requirement that certain Medicaid recipients prove that they worked at least 80 hours each month.
U.S. Sen. Bernie Sanders confronted Health Secretary Robert Kennedy about it Wednesday at a Senate hearing.
“Is throwing 13 million Americans off of the health care they have, poor and working class people, keeping America healthy?” Sanders asked.
“Well, I haven't seen that number. I've seen the number 8 million, and … the cuts are not true cuts. The cuts are eliminations of waste, abuse and fraud,” Kennedy said, and he started to explain how at least one million people would lose Medicaid coverage but Sanders cut him off.
The idea of requiring poor people to work to receive public benefits like food assistance has been around since at least the 1980s. The first Trump administration encouraged states to require it for Medicaid.
The Robert Wood Johnson Foundation funded a study of what happened when Arkansas and New Hampshire added a Medicaid work requirement in 2018 and 2019. Katherine Hempstead, senior policy officer at the foundation, said most people who lost their coverage actually did work or were exempt but failed to report it properly.
“That's the really sort of cruel and sad thing about work requirements is the way that it creates savings for the federal government is really this collateral damage of people who, you know, are unable to successfully document what they're doing,” she said. "A lot of people don't have computers. They have to do everything on their phone. They don't always have internet."
The work requirement in the bill would apply to adults in the so-called Medicaid expansion population, whose incomes are slightly higher than the regular Medicaid population.
Amber Lee, director of Protect Our Care Alaska, said most of the 76,000 Alaskans in this category are working already, or qualify for one of the exemptions, because they’re raising a child, are disabled or are entitled to care through the Indian Health Service.
But documenting that monthly work would be a burden for the recipient and for the state, Lee said, and it would fall on the same department that had such a hard time dealing with applications for SNAP, or food assistance.
“I think most Alaskans remember that Alaska almost lost our SNAP benefits because of the enormous backlog that they had. So work requirements are going to be a huge lift for the state,” Lee said. We're going to have to build out the infrastructure to be able to do that.”
Having fewer insured Alaskans means higher cost for the entire health care system and everyone who relies on it, she said.
“It goes up for everybody, because people will wait to get health care until it's an emergency situation. They end up in the emergency room, and that increases costs for everybody, because those are uncompensated costs,” she said.
The bill would also require copays for people who are in the Medicaid expansion population of up to $35 per medical service.
The reconciliation bill is still in House committees. It’s not certain to pass. Some Republicans don’t like the Medicaid changes and some don’t like that it would add to the deficit by continuing tax breaks that were due to expire.
