Connecticut is not a bad place to be on Medicaid, but it’s about to become a lot worse. As an internal medicine primary care resident, I care for many patients insured through Medicaid, a program which allows my patients’ chronic diseases (such as diabetes, high blood pressure, and depression) to be managed according to the most up-to-date evidence available. I screen my patients for colon cancer and cervical cancer. I counsel them to avoid tobacco, drink alcohol in moderation, and comfort them in difficult times. I have a lot to do to help my patients maintain their health.
Now imagine if this scenario became part of my job:
“Well, your blood pressure is looking great, your diabetes is well-controlled, but have you spent 24 hours each week this month looking for work, or in community service? Is it all documented, including contact numbers, so the state won’t take away your health insurance?”
This is exactly what SB 270, to be discussed on Thursday in the Human Services Committee, aims to do.
Historically, Medicaid has provided health insurance for the poor or disabled, and while the number of eligible recipients was significantly expanded under the Affordable Care Act, this was decided by Congress and the Supreme Court.
These new work requirements were proposed by Medicaid/Medicare administrators in a shift from prior policy which has legal scholars questioning if they even have the authority to do so. Kentucky was the first state to have Medicaid work requirements approved, and seven other states as of mid-January had submitted requests of their own.
What’s wrong with this scenario?
First, it doesn’t apply to most Medicaid patients. Among non-elderly, non-disabled Medicaid recipients, 60 percent work at least part-time, and most of those who do not work are exempt from the pending law, meaning that they either disabled, caring for family members, or attending school, if we assume a liberal definition of community service. Only 7 percent of Medicaid recipients in a 2016 poll were not working for a reason other than the above.
Second, the additional burden of having to prove to the state work or community service of 20 hours weekly would be a burden both for patients and Medicaid administrators. Has your doctor ever asked you to keep track of your blood pressure readings? It’s time-consuming and easy to forget. If patients aren’t able to verify their work hours for two consecutive months, they lose their insurance. To encourage a small percentage of patients to find work, we’re reaching into the private lives of nearly a million Connecticut citizens, with very little to gain and much to lose.
Third, given that most Medicaid recipients work, this administrative requirement may cost them their health care. If patients lose their health insurance because they’re busy working and don’t submit the documentation to prove it, they’re less likely to remain healthy and keep their job, which seems the exact opposite of what this bill hopes to do.
To be sure, Connecticut is in a budget crisis. As citizens of the state we want to ensure that every dollar spent by our state offers the highest possible return on investment, and Medicaid is a great investment. For every 50 cents Connecticut puts into caring for one of its Medicaid recipients, the federal government chips in 50 cents more.
If people can work, they should. But there are better ways to encourage employment than threatening to take away someone’s health care — and there are surely better uses of our state’s scarce financial resources than paying for a new program to ask most of the 800,000 Connecticut residents on Medicaid to prove they’ve been working.
I can imagine what could happen if Medicaid coverage for any one of my patients is taken away because of the proposed new law: A patient with depression who can no longer afford antidepressants and slips into a depressive or even suicidal episode. A patient whose high blood pressure goes untreated could have a stroke or heart attack. The sad irony is that the costs of these complications are hundreds or even thousands of times the costs of preventing them. Those medical bills could go unpaid without the benefit of insurance coverage, and the patients’ ability to work, after a stroke, or other devastating complication thanks to the loss of health insurance.
It would be as compromised as the reasoning behind this legislation.
Jacob Knox Quinton, MD, MPH is a second-year resident in the Yale Primary Care Internal Medicine program, and the views expressed are his own, not necessarily those of Yale New Haven Hospital or the Yale Primary Care program.