Analysts think Medicaid work requirements pose little political risk

Bevin and President Trump (AP photo)
"Kentucky is one of the poorest states in America, and its residents are among the sickest. Yet the governor's decision to force Medicaid recipients to meet a work requirement — something that could take health coverage away from 100,000 people — is unlikely to carry any political repercussions for the GOP in this deeply red state." Tony Pugh reports for McClatchy Newspapers' Washington bureau.

Pugh notes that 2017 Kaiser Family Foundation poll found that 70 percent of Americans support work requirements for Medicaid recipients, and that Republican Gov. Matt Bevin is betting Kentucky feels the same way.

Kaiser Family Foundation graphic.
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In Kentucky and other states with many low-income residents, people who work but often struggle to pay for health care tend to resent those who get government-subsidized health care, according to Al Cross, director of the University of Kentucky's Institute for Rural Journalism and Community Issues, which publishes Kentucky Health News. "If you can say, 'All we’re doing is requiring people to be more active participants in their health care and require some work-related activities,' I think the general population looks at that and says, 'What’s the matter with that?'" Cross told Pugh.

"Supporters say the Medicaid work policy will cut government dependency, weed out people who don’t really need the assistance and build work ethic among low-income enrollees," Pugh reports. "Critics say the requirement will be expensive to administer, provide an unnecessary barrier to coverage and penalize people who can’t work due to undiagnosed medical problems." Kentucky's new policy estimates nearly 100,000 fewer Kentuckians will have health coverage in five years, than if the policy were not implemented.

Eight other states with Republican governors (Arkansas, Arizona, Indiana, Kansas, Maine, New Hampshire, Utah and Wisconsin) and one state with a Democratic governor (North Carolina) have asked the Trump administration for the green light to enact similar requirements. Several of those states could be battlegrounds in statewide and congressional elections in November. But the Medicaid work requirements aren't likely to be a problem for most Kentucky Republicans, since there are no statewide races this year.

The traditionally lower turnout among low-income voters who would be affected by the measure could also help protect Republicans, Cross said. And it's worth noting that the Kentucky counties with the highest Medicaid rates backed Bevin in 2014, mostly because of social issues such as religion, abortion and anti-Obama sentiment.

But the political dynamics at play in Kentucky may not apply in other states. "It may depend on rival Democrats making a linkage between Medicaid and overall concerns about health care and insurance," Pugh writes. Democrats are likely to emphasize health coverage in elections this year, since 3.2 million Americans lost health coverage in 2017 and it's an issue that most people care about. A poll by Hart Research Associates last week showed that voters cared about health care more than the economy, taxes, immigration, or terrorism in the 2018 congressional elections.

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