A few weeks ago I blogged about Florida’s bill being the worst I have seen nationwide. The bill’s sponsor definitely didn’t read the blog (as was made clear during the House floor debate), nor did he seem concerned about the many valid criticisms raised during the debate, and the bill passed the House last week on a straight party line vote of 71-44.
The legislature is set to adjourn this week and, fortunately, it appears that the Senate will not follow suit. If this prediction holds, the bill will not be enacted this session. That is a huge relief, but comments made by Sen. Aaron Bean (R-Fernandina Beach), an influential Republican Senator on health care , suggest that this bill may return next session – especially as an election looms – if it is seen as good politics for the majority.
Why is this bill so problematic?
First, and most importantly, the bill creates a no-win situation which can only result in very poor parents (likely mostly mothers) losing their health insurance as they struggle to support their families. We call this the “Catch-22 proposal” because the essence of the impact in a state like Florida, which has not expanded Medicaid under the Affordable Care Act, is that parents—the ONLY adults subject to the new rules in the bill—have to be so poor to get Medicaid that the income associated with the new work hours (at minimum wage) would make that mother too “rich” to be eligible for Medicaid. Florida only covers parents that earn up to 32 percent of the federal poverty level, or just $6,825 per year for a family of three.
At the same time, she would not earn enough at minimum wage to be eligible for ACA subsidies in the marketplace – which requires income at or above the poverty line. So this mom would lose Medicaid by meeting the work requirement and likely become uninsured – since employer-sponsored insurance is very rare for low wage workers in Florida. Only 11% of nonelderly Floridians with incomes under the poverty level had employed-sponsored coverage in 2017, and only 26% received employer-sponsored coverage when they earned between 100-200% of the federal poverty level.
And of course she would lose Medicaid if she didn’t comply with the new work rules – this is why she faces a Catch 22. There is no way out.
Even the nation’s leading proponent of Medicaid work requirements, CMS Administrator Verma, has acknowledged this problem.
In an interview with WUSF’s Julio Ochoa in April, I discussed the coverage losses that could occur if Florida’s bill passed. In Arkansas, even though many are exempted (including all parents), 23% of those subject to the new rules have lost coverage. The summary of the Florida bill indicates that more than 500,000 parents would be impacted by the proposal. This means that if a similar result as in Arkansas occurred, more than 100,000 parents in Florida could lose coverage if the bill is enacted.
High as it is, this number is very likely too low – because in Arkansas parents are completely exempt — and by definition parents face more barriers to participating in the workforce – such as a shortage of affordable child care. Moreover, Arkansas has expanded Medicaid under the ACA so this Catch-22 situation does not exist there. As a result, those parents that meet the work hours will lose coverage as well.
And as regular readers of SayAhhh! know, when parents lose coverage, children will too. There are other reasons that taking away coverage from parents is harmful to children as well – the entire family is put at risk of medical debt and bankruptcy – further setting these very vulnerable families back in their efforts to escape poverty. And an uninsured parent is less likely to access treatment that she needs – such as for conditions like maternal depression. This can in turn inhibit parent-child bonding and healthy development.
One final point — the long list of exemptions trotted out by the bill sponsor at every turn, shouldn’t make anyone feel better. There is no guarantee that the exemption process will work well in reality. But even if it did, it doesn’t address the Catch-22 the bill creates.
Moreover, the exemptions are actually the least generous in the nation. We looked at proposals from Alabama, Mississippi, and Oklahoma – all states where a similar Catch-22 situation will be created if the Trump Administration approves their pending Section 1115 waiver proposals. These are all terrible proposals as well, but they do exempt more parents right out of the gate than Florida.
Florida’s bill applies to all parents and caretaker relatives regardless of age – Oklahoma exempts those age 51-64 (think grandparents taking care of their grandchildren here!). Both Mississippi and Oklahoma exempt parents with kids under age 6, and Alabama exempts these parents as well if appropriate child care is not available. Florida’s bill applies to all parents unless they have an infant younger than 3 months of age.
All of these work requirement proposals are built on faulty assumptions and backwards logic. Medicaid functions as a work support that can help struggling parents get a job and keep a job. Most adults on Medicaid who can work do so already, and if they don’t there is usually a good reason why not – like they are taking care of their children!
 H/t to our student intern Andrea Dressel for pulling this information.