Medicaid Work Requirements Exist to Punish the Poor

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The New York Times’ Upshot blog has a depressing look today at Arkansas’ Medicaid work requirements, which earlier this month were reported to have already led to 4,300 people getting kicked off their health coverage. There are a lot of problems you can imagine with meeting these requirements, not least finding a job or a volunteer placement in the first place, but other, much more basic problems: It seems that a lot of Medicaid recipients simply don’t know about the requirements at all.

While state officials told the paper they had made multiple efforts to reach those affected, including by mailing letters and distributing fliers, those efforts don’t seem to be working:

But it seems that not everyone opened or read their mail. Ray Hanley, the president of the Arkansas Foundation for Medical Care, which ran a call center for the state, told my colleague Robert Pear that many people never answered their phones. The state said the open rate on emails was between 20 and 30 percent.


Jessica Greene, a professor of health policy at Baruch College in New York, visited three Arkansas counties last month and interviewed 18 Medicaid beneficiaries. Twelve of them were unaware of the work requirement, according to an article she published on the website of the journal Health Affairs.


Another major roadblock for the state’s Medicaid recipients: They’re required to log their hours on the state’s deeply shitty website, which looks like a Geocities page from 1998 and literally has a picture of a key on a keyboard on it. The Times post challenges readers to try and find where Medicaid recipients are supposed to log their hours; I think I found it, but when you click through this link, you’re taken to a login page where you have to sign up. Also, the second time I opened the page, the link no longer worked. The website also didn’t work when I tried to use it on my iPhone.

The National Digital Inclusion Alliance, an advocacy group that promotes internet access for the poor, noted this morning that “Arkansas has the deepest digital divide of any of the states with approved work requirements, with 45 percent of households lacking access to home broadband internet service.” Poor people across the U.S. are much less likely to have home broadband access. NDIA also noted that in other states with work requirements, like Kentucky and Indiana, low-cost internet plans offered by major broadband providers are only available to Supplemental Nutrition Assistance Program (SNAP) recipients, who are already exempt from the Medicaid work requirements—though the federal government mandates a work requirement for SNAP coverage, too, under a law signed by Bill Clinton.

Work requirements are not about getting people into work; there’s no evidence to show Medicaid work requirements work like that, whereas evidence does show they won’t. Other studies show they will worsen health outcomes and cause thousands of people to lose care simply because they can’t jump through the administrative hoops even if they do qualify for coverage. The Arkansas Republicans who pushed these requirements on their citizens don’t care if a single person gets a job because of this, or if thousands of people lose their coverage every month otherwise. They don’t care if the people affected aren’t aware of the new requirements. They don’t care if the website where they’re required to register doesn’t work and would confuse even the most internet-addled millennial out there.


Not only do they not care; they actively want people to be discouraged and confused by, or even entirely unaware of, these requirements. The requirements are hard to fulfill on purpose. They want to create an underclass of sick, poor, disenfranchised, miserable people. Their ideology requires the existence of this misery. This plan doesn’t even make the rich richer, at least not directly; it just punishes poor people for the crime of being poor.