Skip to main content
Subscribe
  • Login
  • My Account
  • Logout
  • Register For Free
  • Subscribe
  • News
    • Current News
    • Providers
    • Insurance
    • Government
    • Finance
    • Technology
    • Safety & Quality
    • Digital Health
    • Transformation
    • ESG
    • People
    • Regional News
    • Digital Edition (Web Version)
    • Patients
    • Operations
    • Care Delivery
    • Payment
    • Midwest
    • Northeast
    • South
    • West
  • Blogs
    • AI
    • Deals
    • Layoff Tracker
    • HLTH 2024
    • Sponsored Content: Vital Signs Blog
  • Opinion
    • Letters
    • From the Editor
  • Events & Awards
    • Awards
    • Conferences
    • Galas
    • Virtual Briefings
    • Webinars
    • Nominate/Eligibility
    • 100 Most Influential People
    • 50 Most Influential Clinical Executives
    • 40 Under 40
    • Best Places to Work in Healthcare
    • Healthcare Marketing Impact Awards
    • Innovators Awards
    • Diversity Leaders
    • Leading Women
    • Best in Business Awards
    • The 2030 Playbook Conference
    • Innovations in Patient Experience
    • Leading Women Conference & Awards Luncheon
    • Leadership Summit
    • Workforce Summit
    • Best Places to Work Awards Gala
    • Diversity Leaders Gala
    • - Looking Ahead to 2025
    • - Financial Growth
    • - Hospital of the Future
    • - Value Based Care
    • - Looking Ahead to 2026
  • Multimedia
    • Podcast - Beyond the Byline
    • Sponsored Podcast - Healthcare Insider
    • Sponsored Video Series - One on One
    • Sponsored Video Series - Checking In with Dan Peres
  • Data & Insights
    • Data & Insights Home
    • Hospital Financials
    • Staffing & Compensation
    • Quality & Safety
    • Mergers & Acquisitions
    • Skilled Nursing Facilities
    • Data Archive
    • Resource Guide: By the Numbers
    • Surveys
    • Data Points
  • Newsletters
  • MORE+
    • Contact Us
    • Advertise
    • Media Kit
    • Jobs
    • People on the Move
    • Reprints & Licensing
    • Sponsored Content
MENU
Breadcrumb
  1. Home
  2. Opinion
January 19, 2018 11:00 PM

Editorial: Medicaid work requirements, end of individual mandate raise responsibility questions

Merrill Goozner
  • Tweet
  • Share
  • Share
  • Email
  • More
    Reprints Print
    Merrill Goozner

    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.

    Letter
    to the
    Editor

    Send us a letter

    Have an opinion about this story? Click here to submit a Letter to the Editor, and we may publish it in print.

    Recommended for You
    hims hers
    Hims & Hers raises $1B
    mh-20250514-Michael-Dowling-John-Dangelo
    Longtime Northwell Health CEO Michael Dowling to step down
    Most Popular
    1
    Downside risk, upside payment highlight new CMS innovation agenda
    2
    UnitedHealth Group CEO Andrew Witty steps down
    3
    AI health risk assessments aim to boost Medicare Advantage pay
    4
    Why healthcare staffing companies are buying competitors
    5
    Docs set for Medicare pay hike under House GOP bill
    Sponsored Content
    Get Newsletters

    Sign up for enewsletters and alerts to receive breaking news and in-depth coverage of healthcare events and trends, as they happen, right to your inbox.

    Subscribe Today
    MH Magazine Cover

    MH magazine offers content that sheds light on healthcare leaders’ complex choices and touch points—from strategy, governance, leadership development and finance to operations, clinical care, and marketing.

    Subscribe
    Connect with Us
    • LinkedIn
    • Twitter
    • Facebook
    • RSS

    Our Mission

    Modern Healthcare empowers industry leaders to succeed by providing unbiased reporting of the news, insights, analysis and data.

    Contact Us

    (877) 812-1581

    Email us

     

    Resources
    • Contact Us
    • Help Center
    • Advertise with Us
    • Ad Choices
    • Sitemap
    Editorial Dept
    • Submission Guidelines
    • Code of Ethics
    • Awards
    • About Us
    Legal
    • Terms and Conditions
    • Privacy Policy
    • Privacy Request
    Modern Healthcare
    Copyright © 1996-2025. Crain Communications, Inc. All Rights Reserved.
    • News
      • Current News
      • Providers
      • Insurance
      • Government
      • Finance
      • Technology
      • Safety & Quality
      • Digital Health
      • Transformation
        • Patients
        • Operations
        • Care Delivery
        • Payment
      • ESG
      • People
      • Regional News
        • Midwest
        • Northeast
        • South
        • West
      • Digital Edition (Web Version)
    • Blogs
      • AI
      • Deals
      • Layoff Tracker
      • HLTH 2024
      • Sponsored Content: Vital Signs Blog
    • Opinion
      • Letters
      • From the Editor
    • Events & Awards
      • Awards
        • Nominate/Eligibility
        • 100 Most Influential People
        • 50 Most Influential Clinical Executives
        • 40 Under 40
        • Best Places to Work in Healthcare
        • Healthcare Marketing Impact Awards
        • Innovators Awards
        • Diversity Leaders
        • Leading Women
        • Best in Business Awards
      • Conferences
        • The 2030 Playbook Conference
        • Innovations in Patient Experience
        • Leading Women Conference & Awards Luncheon
        • Leadership Summit
        • Workforce Summit
      • Galas
        • Best Places to Work Awards Gala
        • Diversity Leaders Gala
      • Virtual Briefings
        • - Looking Ahead to 2025
        • - Financial Growth
        • - Hospital of the Future
        • - Value Based Care
        • - Looking Ahead to 2026
      • Webinars
    • Multimedia
      • Podcast - Beyond the Byline
      • Sponsored Podcast - Healthcare Insider
      • Sponsored Video Series - One on One
      • Sponsored Video Series - Checking In with Dan Peres
    • Data & Insights
      • Data & Insights Home
      • Hospital Financials
      • Staffing & Compensation
      • Quality & Safety
      • Mergers & Acquisitions
      • Skilled Nursing Facilities
      • Data Archive
      • Resource Guide: By the Numbers
      • Surveys
      • Data Points
    • Newsletters
    • MORE+
      • Contact Us
      • Advertise
      • Media Kit
      • Jobs
      • People on the Move
      • Reprints & Licensing
      • Sponsored Content