Messing with Medicaid is a bad idea

Back in May of 2013, then-Gov. Earl Ray Tomblin made the decision to expand Medicaid coverage to low-income families earning up to 138 percent of the federal poverty level.

By that one act, I think he did more to relieve unnecessary human suffering than any number of his predecessors. Maybe more than all of them put together.

Medicaid expansion was an option under the Affordable Care Act. It was originally intended to apply to all states, but this provision was struck down by the US Supreme Court in 2012. Since then, it has become a state option.

That decision has been a lifesaver and a game changer for tens of thousands of West Virginians. As of Feb. 19, 158,137 West Virginians are enrolled in Medicaid expansion. That’s a little shy of one out of 10 state residents, but not by much. In any given year, around 200,000 people have received coverage due to Medicaid expansion.

Most people who gained health coverage came from working families not otherwise eligible for traditional Medicaid.

A lot of the credit for that goes to the West Virginia Department of Health and Human Resources, which did an amazing job of reaching out to and enrolling eligible citizens.

I’m not sure how much this weighed on Gov. Tomblin’s decision at the time, but the expansion opened the gates of treatment for addiction and, ultimately, recovery for thousands of West Virginians struck by the opioid epidemic.

In the words of Nan Whaley, mayor of Dayton, Ohio, a city that has made great progress in reducing overdose deaths, “If you’re a state that does not have Medicaid expansion, you can’t build a system for addressing this disease.”

Not only did West Virginia do something right, but it did it well. That’s the good news.

The bad news is that there’s a move in the Legislature to impose a policy that has failed elsewhere. The House Finance Committee recently voted to impose on West Virginia a policy that has caused a great deal of unnecessary suffering in Arkansas.

The failed policy sounds good, at a superficial level: Let’s impose work requirements on those who receive expanded Medicaid coverage.

I’ve used this Bible verse more than once, but it still fits: “There is a way which seemeth right unto a man, but the end thereof are the ways of death.”

Instead of promoting work, it increases bureaucratic costs and reporting requirements and results in cutting people off for no good reason.

By August 2018, over 18,000 enrollees out of 62,000 — nearly one out of three — in the Arkansas program had been cut off. There’s no evidence whatsoever that those people are doing more work, but it’s a safe bet that they are worse off.

Closer to home, Kentucky has applied for a waiver to impose a similar but more draconian work requirement on its Medicaid population. According to the research of Simon Haeder of West Virginia University’s Rockefeller School of Policy and Politics, if West Virginia would follow suit, this would impact 95,000 West Virginians, including those who are unemployed or who are working but can’t get enough hours to meet the requirement.

Even if we just assume that West Virginia’s results would be similar to those in Arkansas, we would see over 46,000 people losing coverage. That would be about the same as the entire population of Huntington or Charleston — or of Pocahontas, Doddridge, Calhoun, Pleasants, Pendleton, Tucker and Wirt counties combined.

Apparently, some people didn’t get the memo that having health care isn’t a barrier to employment, it actually helps you stay in the game. I know plenty of people, myself included, who are working and paying taxes today but would probably have been disabled or dead without health care.

For that matter, cutting people off from Medicaid doesn’t just hurt those individuals, it also affects local hospitals and health care providers, reduces money coming to local communities and can have a negative effect on employment. And it drives up health care costs for everyone else by increasing emergency room visits and uncompensated care.

The main support for this seems to come from the same kind of outsider-funded astroturf groups that gave us education “reform.” Last year, one of these types of bills succeeded, resulting in new state code that took basic food assistance away from homeless people.

It’s sad to say, but some people in power evidently derive some kind of weird gratification by imposing misery on those less powerful.

Somehow, however, I don’t think most West Virginians are into that kind of thing.

I hope the majority of West Virginia legislators ultimately agree.

(This ran as an op-ed in the Charleston Gazette-Mail.)