OKLAHOMA CITY — The state’s plan to cut off health insurance to poor Oklahomans who don’t work could harm families and increase costs for taxpayers, according to a Center on Budget and Policy Priorities analysis.
If the state is allowed to implement a work requirement on Medicaid participants, Oklahoma’s insurance coverage will worsen, triggering an uptick in the overall uninsured rate, said Judy Solomon, a senior fellow with the non-partisan organization based in Washington, D.C.
That could force the poor to seek treatment at safety-net providers or emergency rooms, which must treat them. Taxpayers, meanwhile, will foot the bill for the uncompensated care, study authors said Tuesday during a media briefing.
The study looked at states — like Oklahoma — refusing to expand Medicaid to cover more low-income adults but now wanting to implement a mandatory 20-hour work week on thousands of the poorest residents — many of them parents.
“All proposals that would take Medicaid away from people for not meeting work requirements are deeply flawed,” Solomon said.
Work requirements can deter people from getting jobs because Medicaid participants risk losing their health coverage if they obtain employment or want to work more hours, the study found.
“If they work, they lose coverage, but if they don’t work, they still lose coverage,” Solomon said.
Even if a parent obtained a part-time, minimum wage job, some make too much to maintain Medicaid eligibility. But they’d be making so little that they’d still be living below the poverty line and unable to receive subsidized coverage under the federal Affordable Care Act, the study found.
Medicaid is Oklahoma’s largest insurer. In all, 795,136 Oklahomans — or nearly one in five — rely on Medicaid, including 529,124 children.
Oklahoma’s Medicaid eligibility level for a family of two is $617 a month, according to the state’s Health Care Authority, which administers the program. A person makes $580 a month — or $6,960 a year — if they worked a minimum wage job 80 hours a month, the report found.
Many part-time employers, meanwhile, don’t offer health benefits.
Still, Oklahoma lawmakers are moving forward with a proposal to require all Medicaid recipients to work at least 20 hours a week.
Nearly 6,000 to 8,000 Oklahomans between the ages of 19 and 50 could be affected by proposed work requirements because they don’t qualify for exemptions, said Health Care Authority spokeswoman Jo Stainsby.
Oklahomans who are physically or mentally unfit; pregnant; caring for a child under six or one with a serious medical condition or disability; or are in rehab; or enrolled in school or job training would be exempt under the current work proposal, which is currently awaiting Gov. Mary Fallin’s approval.
Stainsby said while the state plans to submit the request for federal approval by October, no state that has rejected Medicaid expansion has been permitted to implement work requirements yet.
“We’re kind of going into uncharted waters with how they’re going to respond to it,” she said.
In a statement, Fallin said Oklahoma families “deserve the opportunity to elevate their station in life and increase wealth and health outcomes.”
Medicaid is designed as a safety net for the most vulnerable, and those individuals will continue to be exempt, she said. But it is critical to provide expectations for those able to work, she said.
“The goal of this policy is to equip our citizens with the tools they need to be successful and lead independent lives,” she said. “Some have injected cynicism into this ideal by claiming that the government wants to kick people off of public assistance. That is simply not true. In crafting this policy, we have taken great care to ensure that the structure is in place to facilitate a smooth transition from dependence to independence.”
Fallin said if Medicaid recipients achieve higher earnings due to work requirements and no longer qualify, they could apply for an individual health insurance plan with InsureOklahoma.
Craig Jones, president of the Oklahoma Hospital Association, said while the number of people affected by the work requirement seems relatively small, hospitals are concerned more uninsured Oklahomans will need care in emergency rooms.
He said his members aren’t convinced the plan will net “huge savings.”
Solomon said many Oklahomans currently unemployed face significant employment barriers. Many live in rural parts of the state, have no reliable transportation, lack job skills or can’t access or afford child care, Solomon said.
The study authors noted states are not offering increased child care assistance and said seven-year-old children can’t be left home alone, either.
“Lack of child care assistance is a major concern,” said Jessica Schubel, a senior policy analyst. “That’s because (parents) have to figure out how to balance child care responsibilities with working 80 hours or more a month. Without child care assistance, many parents won’t be able to comply with the work requirements.”
Also, insured parents are more likely to ensure health care for their kids, she said. Children are less likely to get the health care if their parents don’t have it, the study found.
“When parents lose coverage, kids get hurt,” Schubel said. “It’s a double whammy for them.”
Janelle Stecklein covers the Oklahoma Statehouse for CNHI’s newspapers and websites. Reach her at email@example.com.