Column: Medicaid reform requires thought

Michael J. Clark

If you’ve been paying attention to local news, you’ve doubtless heard that our state is considering attaching a work requirement to Medicaid. As you wade your way through tweets, articles and headlines, I wish to offer one small piece of advice: be careful what you read.

Many people – from pundits to politicians to ordinary citizens – are making sweeping claims about this legislation – claims that, more often than not, make the solution seem more obvious and easier than it really is. We all are susceptible to certain types of errors when it comes to our political views, so here is a list of three things that can help you avoid such errors when forming your personal ideas about the bill: individual stories, big and little numbers, and provision rhetoric.

Individual Stories. Human beings are wired in such a way that we give one individual’s story far more credence than statistics and numbers. Imagine that a family member tells us of a co-worker who ate a lot of saltine crackers and developed a rare kidney cancer. Very few people even hesitate to connect the dots. We all of sudden have the medical expertise to know that we should be careful with saltines.

When it comes to the work requirements for Medicaid, ask yourself: what stories come in to play? Pundits will often want you to imagine one person who slips through the cracks of the policy and conclude that if a policy produces such an outcome, it must be an inherently bad policy. Don’t let one story override logic. There are bad stories on both sides of any policy, and what we really have to consider is how often those bad stories play out.

Big and Little Numbers. One of the reasons we trust stories more than numbers is that we all know numbers can be used to deceive – and the Medicaid discussion is no exception. Many have pointed to the recent University of Michigan study published in the Journal of the American Medical Association, highlighting its finding that only 27.6 percent of the individuals in Michigan who were on Medicaid were out of work. This doesn’t sound like a very high number – but what those who point to this study leave out is the fact that we’re talking about 27.6 percent of the over 2 million people receiving Medicaid in Michigan. Be aware of how the numbers you read are being used.

Provision Rhetoric. A final issue to consider is how both sides are talking about Medicaid provision. As a recent Vox article observed, the level of public support given to work requirements depends on how the question is framed. A Kaiser Family Foundation study found that 70 percent of respondents supported allowing states to impose work requirements for Medicaid. However, the Center for American Progress showed a majority (57 percent) opposed denying Medicaid health coverage to those without a job.

How is this possible? Ultimately, it’s because the two polls asked different questions. Notice the language at use here. The first poll asks if it would be acceptable to have an additional requirement in order to get Medicaid. The way this question is framed reminds the respondent that in order for someone to receive Medicaid, someone has to provide it – if you want Medicaid that is fine, but those giving it to you have some requirements they’d like you to meet. The second poll, by contrast, foregrounds the fact that people may be denied Medicaid – calling attention much more purely to the negative outcome for the individual. Both polls may say something about public opinion – but the framing of the questions can influence what we take away from them.

Tough decisions like this deserve our best, most thoughtful consideration. Too often we treat these thorny issues as no-brainer policies and only listen to arguments in favor of our judgment. But this is a matter of such grave importance that you might want to consider a few of the questions I’ve laid out above before you reach out to your representative or speak out on social media. Our fellow Michiganians deserve our best judgment. Let’s make sure we’re giving it to them in the days and weeks to come.

Michael J. Clark is an associate professor of economics at Hillsdale College.