In the revised version of President Trump's proposed replacement for Obamacare, the American Health Care Act, House Republican leaders revealed several changes on Monday that they hope will help the replacement pass the vote in Congress. Over the last couple of weeks since the initial draft was introduced, negotiations have been ongoing as the GOP attempts to address public and political concerns about the bill. One change may appease some members of Congress, but could have serious ramifications for Americans, including children. Here's how the work requirement for Medicaid would hurt families.
The GOP plans to make employment a conditional requirement for receiving Medicaid, which seems to assume that the vast majority of people who receive benefits don't have a job. Some individual states had already done something similar, though these experimental programs weren't overwhelmingly successful, according to Vox. Often times, what resulted was a large number of people who not only didn't have jobs — they didn't have insurance, either.
One of the primary goals of the GOP, and by extension the American Health Care Act, is repealing Obamacare. While millions of Americans would lose insurance coverage if their access to the marketplace is terminated, according to reporting by the Congressional Budget Office, there are even more people who would stand to lose coverage because of proposed changes to the Medicaid program.
Misconceptions About Why Families Have Medicaid
The narrative about "lazy" people taking advantage of government benefits has been around about as long as the benefits programs have been, but they aren't backed up by statistics. Among beneficiaries, 8 in 10 people live in a working-family household, and the majority are employed themselves, according to The Kaiser Family Foundation. Additionally, of the Medicaid enrollees who are employed the majority are employed year-round and full-time. More than half report working more than 40 hours a week, in fact. Despite that, because many are working minimum wage jobs, they are still making so little money each year that they remain at the federal poverty line, meaning they are able to receive Medicaid. Of those who are not working full-time, the reasons cited among beneficiaries include being unable to find work, they are also attending school, or they have family obligations.
The narrative also tends to imply that people working minimum wage jobs should just "get better jobs" — which assumes, first of all, that they aren't already trying to do so (particularly by trying to both work and attend school) and that there are "better jobs" available to them. By removing the expansion entirely, and imposing a work requirement, the GOP will make it impossible for an entire demographic of Americans to access health insurance — a demographic that they paint as being "leeches," but who, in reality, are some of the hardest working people in the American population.
Impossible Choices For Parents
Statistically speaking, there are thousands if not millions of working Americans who are either working more than 40 hours a week if you add up the time they spend on paid labor, the time spent trying to complete their education, and time spent raising their families.
Many parents are stretched thin between these obligations, and receiving Medicaid benefits may be one thing they have been thankful not to have to worry about. Just because someone is working full time (or beyond) doesn't mean they'll receive benefits through their job. Some industries — like food service — are among the worst when it comes to access for benefits — and over a million Medicaid beneficiaries work in the food service industry, according to Kaiser. Parents who have to devote such a high percentage of their time, energy, and focus to work are already spending time away from their families. In some scenarios, one parent may be able to wrangle childrearing responsibilities so that another can work — but if both parents have to work in order to maintain Medicaid benefits, it could throw their family life into a tailspin. That's assuming both parents can find work to begin with, as pointed out by the Center on Budget Policy Priorities.
When Parents Suffer, Whole Families Suffer
Many children can still receive CHIP benefits regardless of their parents' coverage status — and even if their family makes too much money to qualify for Medicaid. But uninsured parents can certainly create stress that kids will be affected by. One reason that unemployed Medicaid beneficiaries cite for not working is trouble finding childcare, which implies that there is an entire demographic of Medicaid beneficiaries with children in their household.
Another reason Medicaid beneficiaries don't work — and the most cited, according to Kaiser's data — is due to illness or disability. If a child's parent gets hurt or ill and is unable to work, having Medicaid benefits may be the only type of financial or social support the family has to get through that crisis. If Medicaid benefits become conditional to work, and a parent is not eligible for disability, the resulting limited access to healthcare could have grave effects on their children. Additionally, having benefits through Medicaid may be what gets a parent who has been unable to work back into the workforce. Those benefits may allow them to access healthcare services that could treat a condition preventing them from working., according to The New York Times. Without access to treatment, a parent could become permanently disabled, or even die, if they are unable to access healthcare services — leaving their family in both an emotional and economic lurch.
Many people also have pointed out that Medicaid benefits cover millions of U.S. children, and have therefore challenged the logic of a work requirement. Despite this, Rep. Gary Palmer, a Republican from Alabama, defended the work requirement for Medicaid by saying, according to The New York Times:
The Medicaid expansion has created a perverse incentive for states to provide benefits to able-bodied adults at the expense of the elderly, the blind and the disabled. A work requirement would help states focus their limited resources on the truly needy.
It's unclear who he thinks the truly needy in this circumstance are: those who have disabilities, children, and pregnant women — arguably some of the most vulnerable members of the population — may be presented with barriers under the ACHA in terms of access, but the work requirement would not likely be one. The people trying to find work, get a college degree, and take care of their families certainly seem like they could be in need of, at least, basic human kindness, and, certainly, quality healthcare.