Fending Off Major Cuts May Be the Bigger Fight, But Medicaid Work Requirements Are Also a Bad Idea | Leanne Berge, J.D., CEO of Community Health Plan of Washington

Part 3

Medicaid advocates, Medicaid managed care plans leaders, and some Democrats were readying themselves for a fight over making work or other requirements a condition for eligibility for Trump. Now they are facing the prospect of much broader and deeper cuts to federal funding of Medicaid, and work requirements could enter the picture as a negotiation tactic to fend off the major cuts that House and Senate Republicans appear to be considering.

“It's bad health policy, and it's not something that we would support,” Leanne Berge, J.D., said about work requirements in a recent interview with Managed Healthcare Executive. “But at the same time, if it means less loss of funding and less loss of eligible enrollees…we would fight that less than we would fight something that has greater impact.”

Berge is CEO of Community Health Plan of Washington, a not-for-profit health headquartered in Seattle that has nearly 350,000 members, 290,000 of whom are covered by Medicaid. Berge, who is also chair of the board of directors of the Association for Community Affiliated Plans, was in Washington, D.C., recently, lobbying members of the House and Senate.

The House passed a budget resolution last week that calls for between $1 trillion and $1.5 trillion in spending cuts over the next 10 years, along with tax cuts that total between $4 trillion and $4.5 trillion. How House Republicans will achieve those cuts is now the subject of intense negotiation, both behind the scenes and through the media, but Medicaid cuts as large as $880 billion over 10 years have been mentioned in the reporting about the budget resolution and its aftermath.

Medicaid is a target for spending cuts partly because President Donald Trump has said Medicare and Social Security are off limits, although he has also mentioned Medicaid in the same vein. In an interview last week with CNN’s Kaitlin Collins, House Speaker Mike Speaker said Medicaid would not be cut and that per capita limits were off the table. He stressed the savings that would be found by rooting out fraud, waste and abuse and also work requirements: “You don't want able-bodied workers on a program that is intended, for example, for single mothers with two small children who are just trying to make it. That's what Medicaid is for, not for 29-year-old males sitting on their couches playing video games. We're going to find those guys. We're going to send them back to work.”

Berge said work requirements (which usually are not limited just to work but can be satisfied with training or going to school) are an added cost for Medicaid programs and plans. “They] cost a lot of money on the administrative side,” she said.

Already working

Moreover, she said, people lose eligibility despite the fact that they are working or are exempt from the requirements just because of problems with reporting and tracking employment. Work requirements "force people to not get the coverage that they need, even though they might very much be appropriately getting Medicaid coverage," said Berge.

Berge also pushed back on the picture drawn by Johnson that Medicaid is covering many people who could work but choose not to.

“When you take a look at who is the focus for the work requirements, the people that are actually so-called able bodied, don't have caretaker responsibilities, aren't also in school, it’s something like 92% that are already working, but they're working in jobs that are too low paying to be able to afford coverage on the market, and their employers aren't paying for health coverage,” Berge said.

Many of the people for whom work requirements are supposed to promote self-reliance are, as a practical matter, already working, she said.

Berge acknowledged that there were some tradeoffs, but she rejected the term “horse trading” for how work requirements might figure into the congressional and political negotiations over Medicaid.

“I don't think you could look at it as horse trading or negotiation as much as, ‘What do you fight the hardest for?’ And for us, it's about fighting the hardest to avoid the worst cuts,” she said.