After insisting that Medicaid enrollees will have to prove they are looking for full-time work in order to qualify for Medicaid coverage, Pennsylvania Gov. Tom Corbett is finally easing up on the requirement, which experts say was unlikely to be approved.
Pennsylvania is one of 26 states rejecting Medicaid expansion offered under the Affordable Care Act, despite the fact that the state has an increasing number of uninsured residents, bucking the national trend. The decision, blasted by health advocates, leaves 500,000 residents in the coverage gap—earning too much to quality for Medicaid but not enough to qualify for tax credits that would allow them to purchase plans under the state exchange.
To reach residents stuck in the coverage gap, Healthy PA proposes to use federal subsidies to help uninsured low-income residents purchase privatized Medicaid insurance plans.
From the initial proposal, Corbett and secretary of the Pennsylvania Department of Public Welfare Beverly D. Mackereth have insisted that enrollees will have to prove they are looking for full-time work to obtain benefits. The original draft of Healthy PA, published back in December, proposed that most enrollees between the ages of 21 and 65 working less than 20 hours a week demonstrate that they were fulfilling 12 job-searching activities a month in order to keep coverage.
No state has ever tethered Medicaid eligibility to searching for employment.
“Historically, work search and work promotion has not been among the statutory purposes of the Medicaid program,” MaryBeth Musumeci, associate director at the Kaiser Commission on Medicaid and the Uninsured, told RH Reality Check. “Unlike the TANF [Targeted Assistance for Needy Families] program, Congress set out the purpose to be promoting work, whereas the purposes of Medicaid is promoting health care.”
After holding public hearings for feedback on the draft, the administration formally submitted the waiver to the federal government for approval in February. The submitted waiver was “gentler” and “softer” on some cuts and conditions proposed in the original draft, but Corbett remained steadfast about the job-search requirement; most enrollees working under 20 hours per week would have to prove they were seeking employment.
He called it the “Encouraging Employment” program.
Corbett’s notion is that the Encouraging Employment program would promote “personal responsibility,” a phrase that appears 30 times in the 202-page document.
From the waiver:
The goal of the Encouraging Employment program is to better enable low-income, able-bodied Pennsylvanians to move out of poverty while also gaining access to health care coverage.
The program will create an opportunity for unemployed and under-employed individuals to connect with potential employers.
The premise of the Encouraging Employment program ignores some basic facts about full-time employment and health insurance coverage. For one thing, the majority of people on Medicaid in Pennsylvania already work full-time, or live with someone who works full-time. Nationally, most uninsured workers are self-employed or work for small firms.
Secondly, the requirement assumes there are jobs to be found. Last week, FactCheck.org called Corbett out when he claimed that he has done a “remarkable” job creating new jobs in Pennsylvania in a series of statewide radio ads.
During his time in office, the number of government jobs has declined by a net 42,000 (most from local government jobs). When looking at all jobs, including government jobs, Pennsylvania has gained 96,300 total jobs under Corbett – a 1.7 percent job growth over three years, ranking the state 46th in total job growth among the states.
Then there’s the fact that less than 60 percent of Pennsylvania employers offer health insurance. Meanwhile, full-time employment fails to enable citizens to “move out of poverty” anyway.
Despite the data, and the unlikelihood of the federal approval, the administration doubled down on the job-search requirement after submitting the waiver.
From Kaiser Health News and the Philadelphia Inquirer:
[T]he administration is sticking to its most controversial proposal: a requirement for work-search or job training.
“We believe it’s important,” said Mackereth. “Encouraging employment ties in strongly to good health outcomes.”
She said the goal is to remove people from public assistance. “We don’t want people to remain on government-funded health insurance. We’re providing tools for people to use.”
Last week, the administration signaled they are backing off. In a letter sent to Health and Human Services Secretary Kathleen Sebelius, Corbett proposed a “potential modification” to the waiver. From the letter, dated March 5:
This proposal will be a voluntary, one-year pilot program to positively encourage those who are able to work, to participate in job training and work opportunities … This pilot program will not be a condition of eligibility, but rather those individuals who participate will lower their premiums and cost sharing as incentives.
MaryBeth Musumeci told RH Reality Check it’s not clear that making the requirement voluntary will be approved, either.
“It still remains to be seen. These waivers enter into a period of negotiation,” she said. “This is still subject to the federal-level comment period through the end of this month, and no decision by CMS would be made before then.”
Pennsylvanians can submit public comment here until March 28.