Another state floats work requirements for expanded Medicaid. Does it stand a chance? | Opinion

Do work requirements actually work?

It’s a question that must be asked after Kansas Gov. Laura Kelly made a renewed effort this month to attract Republican votes for Medicaid expansion. Her new proposal includes a work requirement for recipients of the expanded health care aid — a provision she previously rejected for the state’s food stamp program, but which GOP legislators have suggested is a must-have if the program is ever to pass.

Politically, Kelly’s proposal might be unassailable. If it works, she gets credit for being the Kansas governor who finally made Medicaid expansion happen.

And if it doesn’t — well, it just proves how stubborn Republicans in Topeka are on an issue that has the support of an astonishing 70% of the state’s residents.

But passing Medicaid expansion is one thing. Making it work for Kansans is another. So again, the question is: Do work requirements actually work?

We have a new piece of evidence on that front.

Politico reported on Tuesday that Georgia — another state with a Republican legislature — this year finally passed its own version of Medicaid expansion after a long struggle. But it did so with a hitch: It’s the only state so far to include a work requirement to qualify.

The program started accepting applications in July. More than 30,000 Georgians were expected to sign up.

So far, only 1,800 people have enrolled. That’s not quite zero — but it’s barely more than 5% of what was expected.

Why so few? It’s probably the work requirements.

“It’s a mountain of paperwork,” Chris Pope of the conservative Manhattan Institute told Politico, “and it’s burdensome for people who are in a tough spot.”

You almost suspect that’s the point.

So what does that mean for Medicaid expansion in Sunflower State, and for the 150,000 Kansans here who stand to benefit from the program?

Would they actually benefit if it passes with the work requirement?

Perhaps. Brianna Johnson, Kelly’s spokesperson, told me Georgia’s experience is “completely unrelated” to what the governor has proposed.

“The reason Georgia has struggled to get enrollees is because of the bureaucratic hurdles people have to jump through to prove they’re working, and there are not exemptions,” she said in an email. “Governor Kelly’s proposal includes a work requirement that isn’t bureaucratically burdensome — Kansans have to provide proof of employment once a year while re-enrolling for the program — and provides appropriate exemptions for veterans, Kansans with medical conditions, and full-time students and caregivers.”

Maybe. But there are reasons to be skeptical.

There’s a mountain of evidence to suggest that work requirements — where they’ve been imposed for food assistance and other social programs — don’t really work. They don’t increase employment, but they do discourage the people who need those programs the most from even signing up.

Again, that seems to be the point.

I’m not knocking Kelly here. She’s been fighting the good fight on Medicaid expansion from the moment she arrived at Cedar Crest in 2019, and I’m not going to blame her for doing whatever it takes to get something passed.

And never forget: Republicans in the Kansas Legislature are solely to blame for the lack of movement. Shame on them.

Forty other states and the District of Columbia have passed Medicaid expansion since its inception during the Barack Obama presidency. Tens of thousands of Kansans could potentially benefit, and the vast majority of their constituents want it to happen.

That GOP legislators still have their heels dug in on the issue makes you wonder who the heck they think they’re working for.

The Georgia experience offers a cautionary tale, however. If Kelly’s gambit somehow works — if a work requirement somehow brings enough Republicans to the table to finally, finally pass Medicaid expansion in Kansas — it’s not at all clear that it will be a program worth having.

Passing Medicaid expansion in any form would be a victory. The victory is only meaningful, though, if Kansans actually benefit.

This story was originally published December 28, 2023 at 7:32 AM with the headline "Another state floats work requirements for expanded Medicaid. Does it stand a chance? | Opinion."