As states considering Medicaid expansion explore their options in program design, work requirements have surfaced as part of the debate. While work requirements perhaps serve as a strong talking point in reluctant states, a recent report from the Kaiser Commission on Medicaid and the Uninsured finds that the majority of those who stand to benefit are working adults or in working families.
If every state chose to expand Medicaid, an estimated 14.4 million uninsured adults would be eligible to gain coverage. The Kaiser study profiles those who would benefit and finds:
“Nearly three out of four (72%) of the uninsured adults who could gain Medicaid coverage live in a family with at least one full time or part time worker and more than half (57%) are working or part-time themselves.”
The estimated number of uninsured adults includes those who were eligible but not enrolled under pre-ACA conditions, newly eligible adults in Medicaid expansion states, adults who fall into the coverage gap, and adults in non-expansion states between 100-138% FPL who may currently have access to tax credits in the marketplace.
Of uninsured adults potentially eligible for Medicaid, 11% have multiple full-time workers within one family and 39% have one full-time worker in the family. In non-expansion states, nearly 41% of uninsured adults have one full-time worker in the family.
Given that this population is employed, some may wonder why these adults don’t have access to employer-sponsored insurance (ESI). Kaiser explains that a majority of workers who would become eligible for coverage work in industries that have historically low insurance rates. For example, 46% of uninsured, working adults who would gain coverage are in either the Agriculture or Service industry. The majority (52%) of these adults work for small businesses that have less than 50 workers, thus their employers will not be subject to ACA penalties for not offering coverage.
While over one quarter (28%) of uninsured but potentially eligible adults are not working, many had family obligations or faced other barriers to employment. Nearly one in three (29%) potentially eligible adults were taking care of home or family, one in five (20%) were looking for work, 18% were in school, 17% were ill or disabled, and 10% were retired.
As reluctant states deliberate over whether or not to expand Medicaid, some have explored the possibility of attaching a work requirement to Medicaid eligibility. CMS has made clear that Medicaid eligibility cannot be a contingent on fulfilling a work requirement; still, proposals that include referrals to work programs can and have been approved (see Indiana). While it is encouraging that state legislatures are utilizing the great flexibility allowed in designing a Medicaid program that feels tailor made to their state’s needs, the ongoing discussion of work requirements suggests a fundamental misunderstanding about this population and perhaps why they remain uninsured.
The recent Kaiser fact sheet confirms that the beneficiaries of Medicaid expansion are hard working adults and their families. Work requirements not only fall outside the set goals of a Medicaid program (which is to provide healthcare coverage), but they also imply that beneficiaries are not already working. Hopefully this new research and its fact-driven conclusions can help move the debate forward, and ultimately lead to greater understanding and empowerment for this population of adults.
