On Thursday, January 11th, the Trump administration announced a massive policy shift that would allow states to implement work requirements for Medicaid enrollees. Through its over five decades in existence, the program has never had any work requirements tied to it, receiving coverage through Medicaid is primarily based on income. In 2017, over 74 million people received coverage through Medicaid and CHIP, which is still currently without long-term funding.
There are at least ten states, Arizona, Arkansas, Indiana, Kansas, Kentucky, Maine, New Hampshire, North Carolina, Utah and Wisconsin seeking to immediately implement work requirements for their Medicaid programs, and more will be sure to follow. Though, as the directive states, pregnant women, the disabled and the elderly are exempt, there are many people who will be unable to meet these new requirements for myriad reasons, and will lose their insurance coverage. Two demonized and oft-forgotten populations: those suffering from addiction and the formerly incarcerated, may be the most vulnerable.
The Affordable Care Act’s Medicaid expansion was designed in part to provide coverage for ex-cons, and thousands did receive coverage. Unfortunately, as The Marshall Project reported, the program was implemented very poorly, or in some cases, not at all, and many eligible people left prison without coverage of any kind. For the formerly incarcerated, obtaining employment is often close to impossible. Not only have these people been out of the workforce for months or years, but the pool of potential jobs, volunteer, work-training and educational opportunities is often microscopic due to their criminal record.
A study completed by the Urban Institute on employment after prison found that two months after release, only 31 percent were employed. At eight months, the number rose to 45 percent. Another study found that a criminal record reduces the possibility of a call back or a job offer by nearly 50 percent.
What the federal government should be doing is working to ensure that states have proper protocol in place so that all eligible inmates can obtain Medicaid upon their release. But this recent policy change sends us in the wrong direction entirely. Now, former inmates who have Medicaid and are searching for a job—aside from the pressure of not having money to live, aside from all of the housing issues ex-cons often face—will have to worry about losing their insurance if they are unable to procure stable employment or job training. This provides another sky-high hurdle the formerly incarcerated have to clear in order to reacclimate to society, and it will only serve to bolster the cycle of poverty.
The United States is also experiencing the largest drug epidemic in recorded history, thus, there are more people suffering from addiction than ever before. Maintaining any kind of stable employment while trying to beat a drug addiction is also often impossible.
According to a study by the Kaiser Family Foundation, 3 in 10 people with an opioid addiction are covered under Medicaid. Medicaid has, and will continue to, play an essential role in combating this crisis. All the data shows that medication assisted treatment is the most successful approach to treating opioid addiction. Medication assisted treatment involves using opioid agonists or antagonists (methadone, buprenorphine and, naltrexone) in conjunction with therapy. Buprenorphine (brand name: Subutex) is the most widely known and the most commonly prescribed. As Stat News noted, data from IMS Health found that 1 in 4 buprenorphine prescriptions was paid for by Medicaid.
Though the Trump administration says they will put in exceptions for people receiving active treatment for addiction, this is another bureaucratic obstacle placed between a human being and life-saving medical treatment. It’s not clear what receiving active treatment would mean exactly under these requirements. As Politico reported, many people fear that this change will cause addicts to lose coverage.
Another study by Kaiser found that 60 percent of Medicaid enrollees are currently employed, and of the 40 percent who are unemployed, 36 percent are disabled, 30 percent are taking care of their home or family, 15 percent are going to school, and 9 percent are retired. Another study found that 87 percent of able-bodied Medicaid recipients were currently employed.
Republicans say this move will provide the push to get more people in the job force, but the evidence does not support this claim. When employment requirements were implemented for other social safety net programs, the increase in overall employment was small and decreased dramatically in only a few years.
The bottom line is this: this policy change will not improve people’s lives, it’s yet another calculated slash at the social safety net which will leave fewer people insured.
We should be working to reform the criminal justice system to make it a more rehabilitative enterprise, instead, we’re making life even harder for the formerly incarcerated.
We should be doing everything we can to ensure everyone suffering from addiction receives the best care possible, instead, we are adding another obstacle for them to clear.
Written by Jesse Mechanic
Jesse Mechanic is the editor in chief of The Overgrown.