In recent years, a growing number of states have expanded Medicaid to able-bodied adults to help more families access health care. Instead of achieving that goal, Medicaid expansion has pushed millions of newly eligible individuals into the program’s substandard insurance rolls and denied health care to the truly needy. Fortunately, Michigan recently passed sweeping reforms that will help sick and able-bodied Medicaid recipients obtain quality health care.

In June, Michigan Gov. Rick Snyder signed a bill that requires able-bodied adults to work, volunteer, or attend job training for 80 hours per month to remain eligible for Medicaid. The Medicaid rules would apply to healthy individuals aged 18 to 62. Those who fail to meet these requirements will be shifted out of the program.

Michigan’s reforms are part of a national effort to refocus Medicaid back to helping the truly needy. Ever since Obamacare began offering states preferential funding to expand Medicaid to relatively healthy able-bodied adults, states have diverted resources away from caring for the truly needy. 

As a result, states have limited health care access for patients with debilitating medical conditions. For example, states that expanded Medicaid have forced nearly 250,000 Medicaid recipients with mental illnesses, developmental disabilities, traumatic brain injuries, and other painful conditions to languish on waiting lists for years before they receive treatment. Tragically, many of these patients die while waiting for care. According to state reports, nearly 22,000 children and adults have died on waiting lists in states that expanded Medicaid. These deaths include 5,534 in Louisiana, 8,495 in Maryland, and 1,970 in Michigan.

Shifting able-bodied adults off of Medicaid would dramatically improve care for disabled patients. Following Maine’s disastrous Medicaid expansion, from 2000 to 2010, Republican Gov. Paul Lepage ended the program’s availability for childless and able-bodied adults. Since then, more than 80,000 individuals have exited the program. And as a result, Medicaid can devote more resources for those truly in need. Funding for nursing facilities has increased 40 percent, reimbursement rates for home care has increased 60 percent, and financing for intellectual and developmental disabilities grew by $100 million. Maine’s successful reforms prove that reversing Medicaid expansion is essential for providing reliable health care access to the sickest, most disadvantaged patients.

Many liberal critics argue work requirements deny able-bodied adults health care access when they leave Medicaid. But the reality is individuals who leave Medicaid routinely enroll in private, employer-sponsored insurance when they find work.

When Tennessee decided to end Medicaid’s eligibility for healthy adults, 170,000 enrollees left the program. Most of these able-bodied adults returned to the workforce and joined higher quality employer-sponsored health plans. One 2013 study by Northwestern University found “a steady rise in both employment and health insurance coverage following [Tennessee's Medicaid] disenrollment.”

Employer-sponsored insurance delivers far more reliable coverage than Medicaid. Since these plans reimburse doctors at higher rates than Medicaid, doctors are significantly more likely to treat these patients than a Medicaid recipient. Surveys conducted by the Center for Studying Health System Change discovered doctors across a variety of specialties are several times more likely to accept an individual on private insurance instead of Medicaid.

There is no question that all Americans deserve high quality health care. Thankfully, Michigan’s work requirements will help able-bodied adults obtain employer-based insurance and ensure Medicaid cares for the truly needy.

Charlie Katebi is a state government relations manager at The Heartland Institute.




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