Arkansas Republicans implemented a work requirement for Medicaid recipients last summer, and so far the move has seen thousands of the state’s residents lost their health care coverage — placing many in a desperate and precarious position.
Views differ on the fairness of the unprecedented social experiment, but there’s unanimity here that it’s causing confusion. And that’s feeding a philosophical debate about whether low-income adults are ducking the work rules or just can’t navigate the tech-heavy reporting system that goes offline every night at 9 p.m.
Republican Gov. Asa Hutchinson defended the program, saying it provides the help residents need to become independent. “These are not people that didn’t want to work,” he said in an interview. “It’s just they might not have had the training they needed, or they didn’t have a job opportunity and they needed additional assistance. And that’s what the objective is of the program.”
To date, more than 16,000 low-income adults have been booted from the state’s Medicaid rolls for failing to report a minimum 80 hours of work, job training, volunteering or similar activity.
Politico noted that 4,655 were removed in November, just ahead of the holiday season.
Some of the people thrown off the program describe a nightmarish, confusing experience with clunky technology and no one to help them. Individuals who don't adhere to the new rules for three months get removed from Medicaid for the rest of the year.
“I have pre-existing conditions. But all they could tell me was, 'Sorry, you didn’t comply,'” said Jamie Deyo, who lost coverage and suffers from rheumatoid arthritis and back problems stemming from a 2013 car accident. “It just was a slap in the face.”
After losing coverage, the 38-year-old was unable to go to physical therapy or see her doctor to schedule surgery to repair a broken screw in her back. She’s also had to pay more for medication.
Deyo, who has notes from her doctors confirming she is unable to work, said she would absolutely work if she could: “A lot of people don’t realize how bad I hurt. I can’t stand up a lot.”
But the Trump administration is bent on using work requirements to trim down the number of Americans drawing from the country’s social safety net, after former President Barack Obama’s Affordable Care Act, commonly referred to as Obamacare, expanded Medicaid benefits to millions of low-income adults able to work.
Along with Arkansas, Politico reported, the Trump administration has approved similar work requirement rules in Indiana, Kentucky, New Hampshire and Wisconsin, though in these states the rules have not yet taken effect.
In Arkansas, the implementation has been so chaotic that even those Medicaid recipients who agree with the work requirement rules have complained about the process of logging their hours.
Arkansas officials are belatedly making accommodations for people in a poor state with limited internet access after national backlash from health care advocates, including a new phone line for enrollees to report their hours.
Online reporting kiosks have also been available at county offices. But the state has not hired additional workers to help Medicaid enrollees navigate the new rules, despite the high stakes for non-compliance.
Regardless, Hutchinson continues to defend the rules and has said even if the program was “100 percent successful in every way”, critics would still complain.
Why? “[T]hey don’t believe that any responsibility should have to accompany a social benefit such as Medicaid,” he said.
Democrats have argued that Medicaid was never meant to serve as a jobs program, but their Republican detractors disagree:
“It is reasonable and expected in the United States of America and especially here in conservative Arkansas that people who are able to work will do so,” said state Sen. Jason Rapert. “It is not acceptable for people to think they are entitled for other taxpayers to pay for services for them just because they do not want to work. That is not individual responsibility.”
Deyo, who is struggling to navigate the new rules and take care of her health problems, doesn’t feel entitled to anyone’s money for free services; she simply can’t work.
“I have the doctors‘ notes that say I can’t work; I have their signatures,” she said. “Nobody wanted to hear that from me."