GOP Medicaid work mandate set for Senate vote

Jonathan Oosting
Detroit News Lansing Bureau

Lansing — As she gave her grandchildren an after-school snack Tuesday, Claire Maitre told them about the time her father killed a polar bear in self-defense in Greenland. After the 3-year-old woke from a nap, she told him the latest installment of a story she’s been making up about a little squirrel who has “very squirrel-like adventures.”

Maitre, 62, spends dozens of hours each week babysitting her grandchildren and providing their working parents with free child care. But none of that time or her community service would count as work under an advancing plan that would require able-bodied Medicaid recipients to spend 29 hours a week at a job or risk losing their health care coverage.

“If you were to ask me to get a paid job and leave off caring for my grandkids and my volunteer work, I would choose to go without health insurance,” Maitre, of Scio Township, told lawmakers Wednesday, urging them to reject the bill. “I may seem poor to you, but my life seems rich.”

The Republican-led Senate Competitiveness Committee approved the legislation a short time later in a 4-1 vote. The lone committee Democrat voted against the plan to reform the government health care program for lower-income residents, which has grown significantly in recent years after the state expanded eligibility under former President Barack Obama’s signature health care law.

Repulican President Donald Trump’s administration is encouraging the work requirements and has so far approved waivers for three states, including Kentucky, where opponents have sued in an attempt to block the rules. The full Michigan Senate is set to vote Thursday on the bill.

Sponsoring Sen. Mike Shirkey, R-Clarklake, created exemptions in the Michigan legislation that would waive the work requirement for parents with young children, pregnant women or caretakers for disabled family members. But asked about people like Maitre who could still lose health care, he told reporters the social safety net “by definition, has a lot of holes in it.”

“The best safety net ever invented by God is family,” Shirkey said, “but I’m not sure that government is supposed to supplement that process.”

Shirkey’s legislation, which is the subject of high-level negotiations with Gov. Rick Snyder’s administration and could still change, would require Medicaid recipients to report any work, job training or related education to the state each month through an online portal.

Those who fail to report or do not meet work requirements on at least two occasions would be disqualified from the Medicaid program for a full year.

More than 2 million residents are on some form of Medicaid insurance in Michigan, including more than 670,000 enrolled in the Healthy Michigan plan, which expanded eligibility to up to 133 percent of the federal poverty level. Many already work or are in failing health, and Shirkey estimates about 300,000 able-bodied adults would be subject to the work requirements.

“This isn’t being done to save money,” Shirkey said in a Wednesday morning hearing. “It is being done to ensure … that we have the resources necessary to really help those that really need the help the most.”

Democrats in Congress sent Snyder a letter Wednesday urging careful consideration of the measure, suggesting the work requirements “may be more punitive than helpful.”

The advancing plan has faced criticism from health care and patient advocacy groups, who argue it would create a bureaucratic system that puts a burden on patients and the state, but is supported by several business and conservative groups who argue it would help employers struggling to fill job openings.

“This is an opportunity we have not had in a long time to try to move some folks who have not had a permanent attachment to the workforce into the workforce,” said Charlie Owens, state director of the National Federation of Independent Businesses. “The best program for a family that’s struggling is a good job.”

Mary Mayhew, a researcher with the non-profit Opportunity Solutions Project, compared the Michigan Medicaid proposal to recent food stamp welfare work requirements she helped implement while leading the Maine health department.

Wages increased, people went back to work, and food stamp caseloads dropped significantly, Mayhew told legislators. “That’s the success when you incentivize employment, when you support an effective pathway and stop paying people not to work,” she said.

Critics credited Shirkey with adding more exemptions to the bill for adults who may face barriers to work, but they pointed to studies showing a majority of work-able Medicaid recipients already work.

Requiring recipients to document work hours or qualifying exemptions each month will likely lead to patients with legitimate needs losing coverage, said Ken Fletcher of the American Lung Association.

“Battling administrative red tape in order to maintain coverage should not take away from patient or caregiver’s focus on maintaining their or their family’s health,” Fletcher said. “Failing to navigate these burdensome administrative requirements could have serious, even life or death consequences for people with serious or acute chronic diseases.”

The legislation now heads to the full Senate. Shirkey, who is also discussing the bill with House leadership, said he hopes it will advance to the governor’s desk by summer. Democrats, minorities in both chambers, are expected to oppose the measure.

Sen. Rebekah Warren, D-Ann Arbor, said the proposed exemptions do not go far enough, pointing to a provision that would waive the work requirement for one parent in a couple to take care of a child six years of age or younger.

“In reality, caretakers with children under the age of 12 should be exempt,” Warren said. “Kids can’t babysit themselves at seven years old.”

Shirkey said he is willing to continue negotiations. He personally discussed the legislation earlier this week with Snyder, who has championed Medicaid expansion and not yet taken a public position on the work requirement proposal.

“I am rifle-shot focused on making sure this doesn’t result in a cumbersome administrative process,” Shirkey said. “It is unnecessary to do so.”