mployment should not be a prerequisite to receive medical treatment or coverage, though some states are trying to make that happen. As a physician, I am deeply concerned by several states’ decisions to submit Medicaid waiver applications that would require enrollees to work, search for work, or volunteer in order to qualify for government health coverage.
While these proposals include some positive provisions, such as expanding service coordination to assist participants with accessing affordable care, steady employment or actively searching for a job should never be a condition of eligibility for Medicaid. Instead, these Medicaid waivers should focus on providing greater access to care instead of slapping patients with untenable terms and conditions they must meet in order to take advantage of health services and receive the care they need.
Consider these statistics from the Kaiser Family Foundation: Approximately 8 out of 10 non-elderly adults with Medicaid coverage live in a working household, and 60 percent of non-elderly adults who are Medicaid beneficiaries are already working. In addition, the vast majority of Medicaid enrollees who are not working have a legitimate reason for doing so: a medical condition, a disability, taking care of an ill family member, or being unable to find a steady source of work.
In some states, including Ohio and Michigan, people who are unemployed report that having Medicaid coverage makes it easier for them to search for work, and those currently working say that coverage enables them to continue working. I’ve seen firsthand how my patients depend on programs like Medicaid to get healthy and stay healthy when no other options are available. It’s clear that work requirements would only stymie patients’ abilities to find work and make it more difficult for physicians to keep them healthy.
Medicaid work requirements wouldn’t hurt just patients — they would harm physicians, too. We face a slew of daily challenges, ranging from administrative burdens to physician burnout. Work requirements would put physicians in a precarious situation, forcing them to follow a state’s protocol and possibly deny their patients care at times when they need it the most. Physicians should never be put in the position of participating in a government-mandated process that could risk the health and well-being of their patients or their practices.
The American College of Physicians, which I currently lead, has urged the Centers for Medicare and Medicaid Services to reject proposals from Medicaid agencies in states such as Arizona and Kansas that would make Medicaid contingent on employment. Far more should be done to protect underserved patients who might not be able to meet those requirements. A recent paper in Annals of Internal Medicine showed that lack of health insurance is associated with poorer outcomes, including avoidable deaths — a trend that cannot be allowed to continue.
If Congress and health policy leaders are seeking tangible, long-term solutions to health care reform, Medicaid work requirements are not the answer. It’s time to start focusing on policies that keep patients healthy, not legislation that prevents them from accessing the care they deserve.
Should Medicaid work requirements go into effect, of this I am sure: Paperwork and administrative burdens for physicians will increase, Medicaid enrollment will decrease, and many vulnerable patients will ultimately lose coverage and likely experience poorer health.
Jack Ende, M.D., is the president of the American College of Physicians.