It is time for a review of government benefits, especially the health insurance policies for all politicians, focusing on eligibility requirements. No politician's health insurance should be better than their employers, the people. They should have to meet the same requirements while facing the same restrictions the people face as well as the same cost. It is time to level the playing field.
As Republicans weigh Medicaid work requirements, Georgia offers a warning
Just 12,000 of the nearly 250,000 newly eligible Georgians ultimately received Medicaid, the public health insurance program for the poor and disabled, well short of the state’s initial 50,000 goal. Administrative costs far outpaced spending on medical care. Some who do work had a tough time proving it to state officials — or their work, such as caring for ailing relatives, didn’t qualify.
Georgia’s experiences portend what’s to come if work requirements are imposed nationally, Medicaid researchers said.
“It’s going to be creating this administrative bureaucracy and devastating amount of poor people who, despite being eligible, are going to lose coverage so that Congress can fund tax cuts for the wealthiest,” said MaryBeth Musumeci, an associate professor of health policy and management at George Washington University’s Milken Institute School of Public Health.
A spokesman for Georgia Gov. Brian Kemp (R), who spearheaded the Medicaid expansion with work requirements, called the governor’s health policy a success because hundreds of thousands of low-income Georgians also received insurance from private plans, including more than 1,000 who “graduated” from Medicaid to better health insurance.
“With this success, it’s no surprise that others are starting to emulate our innovative approach to healthcare coverage,” Garrison Douglas, the spokesman, said in an email.
For 60 years, Medicaid has served as the safety net for the impoverished and disabled. Low-income adults without physical or mental disabilities became eligible in 2014 under the Affordable Care Act, although the Supreme Court gave states flexibility to decide whether to extend coverage to them. All but 10 have.
The federal government covers almost the entire bill for those newly eligible for Medicaid. House Republicans are looking to scale back this spending as they search for trillions of dollars to slash from the federal budget.
Legislation advanced Wednesday by the House Energy and Commerce Committee would require adult Medicaid beneficiaries to spend at least 80 hours a month working, training for a job, in school or volunteering. It exempts people who are disabled, pregnant or in postpartum care. The provision is estimated to save $300 billion over a decade by cutting off benefits to millions and preventing others from enrolling.
“We make no apologies for prioritizing Americans in need over illegal immigrants and those who are capable but choose not to work,” Rep. Brett Guthrie (R-Kentucky), the committee’s chairman, said at the start of Tuesday’s budget hearing.
During that hearing, GOP lawmakers said the new eligibility criteria they are proposing would protect people in need of Medicaid by ensuring the financial stability of the program.
Medicaid advocates say work requirements are unnecessary because most recipients already work — often in low-wage or informal settings with no health insurance. Of the 26 million working-age adults who used Medicaid in 2023, 64 percent had jobs, according to KFF, a health policy organization.
Of the remaining 36 percent, 8 percent don’t work because they are retired, cannot find jobs or have some other reason. Most others don’t work because they are caring for a relative, have a disability or are in school.
“It’s not really this huge population of young, able-bodied adults who just aren’t working, are sitting at home and want Medicaid,” said Cynthia Gibson, a health law specialist at Georgia Legal Services Program, which assists residents seeking Medicaid.
Republicans on the House Energy and Commerce Committee say 4.8 million Medicaid recipients are able-bodied adults who choose not to work, citing preliminary estimates from the Congressional Budget Office. Committee staff did not return a request to provide the CBO documents.
Heather Payne, a 52-year-old former travel nurse who stopped working after suffering strokes, said she’s been caught in a bind trying to get back into the workforce while addressing medical expenses from her recovery.
The resident of Dalton, Georgia, went back to school for a master’s degree to become a nurse practitioner but cannot afford to earn enough credit hours to qualify for Pathways to Coverage, Georgia’s expanded Medicaid program. The degree offers only nine credit hours per semester; the state requires at least 11.5.
Because students must be insured, Payne has been forced to use a school insurance plan with limited coverage and high co-pays.
“It feels like I tripped and fell, and I picked myself back up and I started trying to walk and someone is sticking out their foot and trying to trip me again,” said Payne, who was a guest of Sen. Raphael G. Warnock (D-Georgia) at President Joe Biden’s State of the Union address last year.
As a former emergency room nurse, Payne said she saw the occasional patient who seemed to be taking advantage of the Medicaid system. But “you don’t design a system to punish everyone for the small number of people that are fraudulent,” Payne said.
In 2018, the Trump administration allowed states to compel people to work or train for jobs to receive Medicaid. Only two followed through.
Arkansas was the first in the nation to add requirements that resulted in 18,000 people losing coverage before a federal judge struck down the program.
Other states that received federal permission to impose work requirements, including Indiana, Michigan, New Hampshire and Kentucky, never implemented them. Some states have applications to add work requirements pending before the Centers for Medicare and Medicaid Services, including Ohio, Iowa, Arizona and Arkansas, which is attempting to revive its program.
After Kemp narrowly won election in 2018, he embraced work requirements as an alternative path to insuring more Georgians through Medicaid while providing incentives to become self-sufficient.
“This health-care reform will put hardworking Georgians first,” he said in 2019. The Pathways to Coverage program launched in July 2023, after regulatory and legal challenges.
But it faced problems as it rolled out, drawing complaints that it was difficult to sign up for insurance because of a shortage of staff and clunky online application portals. Of the 26,000 applicants in the first 13 months, 1,700 were ineligible solely because they did not meet work requirements. The state did not begin an awareness campaign until more than a year after the program’s launch.
Georgia state officials said enrollment in the Pathways program is more complicated in the context of its health policy. More than 800,000 Georgia residents who are above the poverty line but would normally qualify for Medicaid in other states received private health coverage instead. It was provided through a separate initiative that allows them to receive insurance through Affordable Care Act exchanges.
Georgia’s experiences with Medicaid work requirements are not entirely instructive to the rest of the country because its program applied only to people newly eligible for insurance. The proposal in Congress affects coverage for those already enrolled.
Critics of Georgia’s program say the rest of the country will learn about the administrative burden of work requirements. An investigation by ProPublica and the Current found that three-quarters of the nearly $87 million spent on the program by the end of 2024 went to consultants.
State officials said they had to duplicate some implementation expenses because the Biden administration delayed their initial plans to launch the program in 2021.
The state also decided not to suspend people for failing to report their activities to qualify for Medicaid every month, after some experienced technical challenges and state workers struggled to keep up with the workload. Georgia shifted to annual reporting instead.
“This is really not a fiscally responsible approach if the idea is to save the federal government money,” said Leah Chan, director of health justice at Georgia Budget and Policy Institute, a left-leaning think tank that is monitoring the Pathways program. “It just creates all this additional red tape.”
The Government Accountability Office is investigating the administration of Pathways at the request of the state’s Democratic senators, Warnock and Jon Ossoff.
“There’s no evidence at all that asking people to fill out these forms as Georgia does every single month gets them to the workplace,” Warnock said in an interview. “What it does is it creates a bunch of hurdles and they get dropped from health-care coverage, which apparently is the point.”
Rep. Robin Kelly (D-Illinois) unsuccessfully proposed an amendment to add language that would force a state to drop work requirements if it leads to a significant loss in coverage.
“They are not going to get rid of the work requirements,” Kelly said of her Republican colleagues.
Georgia officials acknowledged shortcomings of the Pathways program in an April report to the Trump administration. They said the rollout was complicated by a simultaneous need to recertify the eligibility of Medicaid patients who remained insured under emergency pandemic rules.
An independent evaluator hired to scrutinize Georgia’s program found that older adults (ages 50 to 64) were more likely to be ineligible for Medicaid under the work requirements and recommended exempting them. The report also recommended exempting family caregivers.
Georgia is seeking federal permission to allow parents who are primarily responsible for caring for young children to receive Medicaid without meeting the work requirements, but older adults and caretakers of other age groups would not be exempt.
Belinda Sherley, a 44-year-old resident of rural Quitman, Georgia, said she can’t work because she cares for her husband, who has severe agoraphobia and anxiety. She received federal food benefits after submitting a letter from her husband’s doctor confirming her account. But when she tried to get Medicaid, she was told there would be no exceptions.
She wants to be on Medicaid so she can see a gynecologic specialist and receive Ozempic for her diabetes. Instead, she relies on a local clinic without a specialist that charges about $25 on a sliding scale for basic care. That’s still a lot of money when the couple’s sole source of income is less than $1,000 a month from her husband’s disability payments.
“Work requirements are great if you’re able to work,” Sherley said. “I’m falling through the cracks.”
