Out of work? Don't dare get sick under Medicaid | Commentary

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The Pennsylvania Senate will soon vote on House Bill 2318.

As a primary care physician, I hear frequently from my patients about the challenges of navigating complex health systems and insurance coverage, as well as the high cost of health care. I have spent time with patients who are trying to figure out how to pay for health care during unexpected insurance gaps, and I know that when health insurance coverage lapses, families suffer.

The Pennsylvania Senate will soon vote on a bill that would put health coverage for thousands of Pennsylvanians at risk. House Bill 2138 would impose work requirements for Medicaid enrollees, forcing individuals enrolled in Medicaid to provide proof of work in order to maintain enrollment, or prove that they meet one of the specific criteria to be exempted from the requirements.

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Medicaid provides essential health coverage for low-income individuals, people living with disabilities, pregnant women, and older adults. The vast majority of Medicaid enrollees are already in a household where someone is working. Many Medicaid enrollees are the primary caregivers for someone else — parents and guardians of small children or children with disabilities, as well as individuals taking care of older family members. Medicaid provides health coverage so that these caregivers can be healthy and take care of those that rely on them. Imposing work requirements forces these individuals to jump through hoops to keep their health coverage and threatens a critical support that families have.

 

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What’s worse, the legislation is punitive, and forces people who aren’t able to adequately demonstrate that they meet the requirements to lose their health care for a period of three to nine months before they are eligible to be covered again. The potential repercussions are serious. Lost paperwork or a missed deadline could result in sudden loss of ability to pay for essential medicines and doctors’ visits.

The proposal is also risky for people who have medical conditions that don’t fit neatly in the exemption criteria. Many people have serious medical conditions that impact their ability to work, but may not meet the criteria outlined in the bill. Health is not static — a person may feel well for months, then unexpectedly experience a flare-up that limits his or her activity for a period of time. For those individuals to risk being locked out of their health insurance because of inability to meet the strict exclusion criteria, or inability to provide the correct paperwork while they are ill, is punitive and potentially harmful to their health.

 

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Work requirements also result in significant administrative burdens for state governments. Administering the work requirements in Pennsylvania would potentially cost hundreds of millions of dollars, while the toll on families would be great, with thousands of Pennsylvanians at risk of losing their health coverage. Other states provide cautionary tales. In Kentucky, where Medicaid work requirements were recently passed into law, it’s estimated that 100,000 individuals will lose health coverage. We can’t afford that in Pennsylvania.

Interruptions in insurance coverage are associated with worse health outcomes, likely related to the sudden loss of ability to pay for essential medicines and delays in seeking care. Loss of coverage for is also a risk for the health of our communities. Efforts to address major health crises like the opioid epidemic cannot succeed if individuals do not have health coverage and access to needed treatment.

H.B. 2138 creates unnecessary barriers for patients and costly administrative hurdles for our government, and risks the health of thousands of Pennsylvanians. As a doctor, I believe these are unacceptable risks.

 

Rhea Powell is a primary care physician who lives and works in Philadelphia. @RheaEPowell