The individual mandate to buy health insurance is out. Unpaid community service for unemployed workers who sign up for Medicaid is in.
Nine states want to join Kentucky in adding "personal responsibility" requirements to their Medicaid programs, whose statutory purpose is to provide health coverage and long-term support for the poor, disabled and destitute elderly.
Who among these groups are the ne'er-do-well, undeserving poor who will see their health and well-being improve "through incentivizing work and community engagement," as CMS Administrator Seema Verma wrote in her letter to state Medicaid directors?
Less than one-third of the 80 million people on Medicaid are working-age adults. Of that group, 60% are already working full- or part-time and qualify for Medicaid because they make so little money. Among the remaining 10 million, over 90% are disabled, in school or taking care of someone at home.
That leaves less than 1 million people nationwide who are unemployed, able to work and on Medicaid. It's shocking the number is that low.
Despite a 4.1% unemployment rate, there are still 6.6 million jobless Americans actively looking for work, according to the Bureau of Labor Statistics. Moreover, their average time being unemployed is nearly six months, not much less than the nine-month average people spent on the unemployment lines at the peak of the Great Recession.
Forcing people into community service when they are between low-end jobs (retail, restaurants and construction are the main industries employing people on Medicaid) makes no sense. It takes time away from the search for work. Indeed, giving them health insurance aids that search since there's one less reason to reject a low-wage job without coverage.
Court challenges to the 1115 waiver granted Kentucky are already being prepared by Families USA and other advocates for the low-income population. The CMS "has taken it upon itself to redefine Medicaid law, distort Medicaid's objectives, and lawlessly redefine what it has the authority to approve through waivers," the group charged.
There will be no such legal basis for challenging the individual mandate repeal since that's now the law of the land courtesy of the Tax Cuts and Jobs Act.
Eliminating the tax penalties is certain to reduce individual sign-ups on the exchanges, especially among younger, healthier workers. That, in turn, will raise rates and, ironically, raise government outlays to subsidize those who still want to buy plans.
With that year-end handiwork out of the way, Congress is moving to inflict even more damage on the individual insurance market. The GOP wants to repeal the employer mandate, which is slated to raise about $200 billion in penalties over the next decade from the thousands of business owners with 50 or more workers who do not provide health insurance.
Allow me to suggest an amendment along the lines of the philosophy articulated in the Kentucky Medicaid waiver. Any business owner who does not provide health insurance and wants to have the penalty waived must spend 20 hours a week clerking in their local hospital emergency room so they can see firsthand how many people show up for uncompensated care because they have no insurance.
While we're on the subject of hypocrisy, why is there a hue and cry over mandatory health insurance yet none over mandatory auto insurance?
Every state but one requires motorists to carry car insurance, and New Hampshire, the outlier, makes drivers prove they can pay the cost of a major accident before they can opt out.
Let's apply the same rules to health insurance. Any individual who opts out must be able to show they can pay for the cost of an average hospital stay.
And before any business with over 50 workers can opt out of providing coverage, it must show it can afford to pay for any uncompensated care provided to its workers.
