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Boston Globe

Call for Medicaid work requirements is greeted by a chorus of boos

Get The Gavel A weekly SCOTUS explainer newsletter by columnist Kimberly Atkins Stohr. Enter Email Sign Up What Archambault does not acknowledge is that Medicaid serves the working poor, which includes low-wage workers who are working multiple part-time jobs that don't provide coverage or positions that fall just below the threshold that would qualify them for coverage by their employer (an all-too-common practice by companies to avoid providing benefits). Advertisement Moreover, some family members who are caregivers might not be able to meet the work requirement. In a June 2 op-ed, Advertisement Finally, this hyperfocus on which low-income people deserve access to subsidized medical care distracts from what should be the primary focus: that our federal leaders are promising 'savings' on the cost of benefits in order to advance massive tax cuts that will benefit the wealthy and increase the national debt. Rosemarie Buxton Haverhill With health care costs skyrocketing, reform is needed — but not this kind My Pioneer Institute colleague, Josh Archambault, is correct that we do need Medicaid reform, but the solutions he offers, an old trope of work-or-volunteer remedies that recall the 'welfare queen' stereotype of 40 years ago, will As Archambault states, the original idea behind national Medicaid was to provide health insurance to seniors and people who are blind or have other disabilities. Over time, however, rapidly escalating health care costs strained the limits of employer-sponsored health insurance, and by 1995 the Since that time, Massachusetts has chosen policies to expand health insurance coverage. Eligibility for Medicaid, known here as MassHealth, has grown to include those who are not only below poverty lines but also those who are at certain levels above poverty rates. This includes nondisabled people and many more children. At the same time, health care prices in Massachusetts have skyrocketed, with Advertisement Barbara Anthony Cambridge The writer is a senior fellow at the Pioneer Institute and former undersecretary of the Massachusetts Office of Consumer Affairs and Business Regulation. National health safety net is frayed enough as it is Josh Archambault's op-ed does nothing to advance an important debate around our national health safety net. The situation is far more complicated than the talking points he offers. An estimated We have seen this before. When Arkansas and Georgia implemented work requirements, most of the people who lost coverage actually met the requirements but got caught up in red tape. We hear from callers every day on We stand with the Massachusetts congressional delegation in pushing back against the unprecedented health care cuts in the House bill. Advertisement Amy Rosenthal Executive director Health Care for All Boston Instead of prodding the 'able-bodied,' strengthen workforce development Josh Archambault's argument that imposing work requirements on 'able-bodied' adults who receive Medicaid will improve health is wrong on several levels. First, multiple evaluations of the Affordable Care Act Medicaid expansion demonstrate improved health overall and improved outcomes for specific populations (for example, reduced deaths from opioid use). The Second, evaluations of the impact of work requirements for welfare recipients have generally shown the initial increased work participation failed to sustain income or reduce poverty over time because of low wages and insufficient work supports. Third, to get Medicaid via disability, people must meet strict Social Security definitions of disability — a high severity bar — and large numbers of people with significant disabilities do not. Many of the 'nondisabled' childless adults on Medicaid have major mental health conditions, substance use disorders, and developmental disorders, including autism, that significantly affect their ability to succeed in the workforce. The population of low-income adults who became eligible for Medicaid through the Affordable Care Act also includes many parents, who too would be subject to paperwork burdens every six months. Work that provides a living wage is a desirable outcome. Rather than imposing burdensome administrative requirements, real reform means strengthening workforce development policies — at all ages — through apprenticeship programs, other training work, coaching, reliable hours and transportation, and other policies that encourage jobs for previously unemployed people. Advertisement Real reform also means strengthening health care prevention and promotion. MassHealth has taken clear leadership in promoting comprehensive primary care by transforming payment systems and providing incentives for team care, including the integration of mental-behavioral health care. Such efforts should be amplified rather than impeded through work requirement efforts. Dr. James M. Perrin Boston Dr. Charles J. Homer Brookline Perrin is a professor emeritus of pediatrics at Harvard Medical School and John C. Robinson Distinguished Chair in Pediatrics at MassGeneral Brigham for Children and former president of the American Academy of Pediatrics. Homer is senior adviser at Economic Mobility Pathways and former deputy assistant secretary, human services policy, at the US Department of Health and Human Services. The less fortunate don't need more hoops to jump through There are a number of sleights of hand in Josh Archambault's call for Medicaid reform, not the least of which is judging a program that pays for access to our medical system by the outcomes provided by that system. But it's his call for government-mandated community engagement as a condition for having your doctor's visit subsidized that is truly gobsmacking. It was not so long ago that such a proposal would be derided by conservatives as government social engineering because, among other things, it's literally that. Does Archambault truly believe that the federal government is capable of creating a meaningful social fabric for the less fortunate among us, or does he think that, as proven time and time again, adding requirements to social safety net benefits will simply discourage recipients from applying, thus reducing the costs of the programs? Saul Tannenbaum Boston