Medicaid irony

Mississippi Gov. Phil Bryant is apparently thinking about pursuing a work requirement for able-bodied Medicaid recipients. Yet the Republican had the chance to extend Medicaid to the working poor and rejected it.

How would he square this irony?

Mississippi has about 300,000 workers who make too much, according to the state’s current income threshold, to qualify for Medicaid but too little to be able to afford health insurance. When Obamacare was enacted several years ago, it offered Mississippi a cheap way to provide coverage to these low-income workers. The federal government would pick up most of the tab.

But Bryant thumbed his nose at the sweet deal, as did most of the nation’s other Republican governors, some of whom have since relented. Why did Bryant resist? For mostly political reasons. He thought there was more to gain for him in this GOP-dominated state to buck anything connected to then-Democratic President Barack Obama. It didn’t matter that Bryant left tons of people a major illness away from bankruptcy, or that he added to the load of uncompensated care at already struggling hospitals, or that he missed out on the several thousand health-care jobs Medicaid expansion would have created. It was a decision that was cold-hearted. It also was economically dumb. This refusal to expand Medicaid is one reason Mississippi’s recovery from the Great Recession still remains sluggish a decade later, while the rest of the nation, including our neighboring states, has largely come out of it.

If Bryant really wanted to reward the poor for taking the initiative to work, he had a perfect opportunity to do so. He said no.

So, the idea of adding a work requirement to Medicaid — if it can get the approval of the federal government — should be received with skepticism.

If some Medicaid recipients are gaming the system, as those who back the work requirement suggest, one has to wonder how so. Unlike with welfare or disability programs, there are no cash payments to those who qualify for Medicaid. All of the reimbursements in the federal-state health insurance program go to the medical providers — doctors, hospitals and clinics. It is these providers, especially hospitals, that the program mostly saves. That’s because by law they would still have to provide the treatment if the patient showed up uninsured at their emergency rooms; they just wouldn’t get paid for it.

A work requirement for the able-bodied poor certainly would make life harder for them. Most of its hurt, though, would be on the state’s health-care industry.


Refill Café is a developing organization, run by Jeff Good, that will open late this year.