Idaho has undertaken a crusade to rid its businesses of government red tape and burdensome, purposeless administrative rules. The governor and Legislature have celebrated the elimination or simplification of about 40% of the state government’s rules and are taking aim at another 15-20 percent of those pesky regulations.
At the same time, the government has imposed a hefty red-tape burden on working folks who earn too much to qualify for Medicaid, but too little to qualify for subsidized insurance under the Affordable Care Act. Idaho voters said last November that the people in this gap should be able to get healthcare under Medicaid without a bunch of bureaucratic red tape. The Medicaid expansion initiative passed with a 61% vote.
However, the Legislature could not resist adding some burdensome requirements to the people-passed law, including a so-called work requirement. Actually, most able-bodied folks in the Medicaid gap are working people. If they were not working and making too much to qualify for Medicaid, they probably would already be getting Medicaid and would not have to worry about how they were going to stay healthy.
The work requirement will not force people in the gap to get a job because most of them already have one or more already. What it will force them to do is to file government reports in order to maintain their Medicaid eligibility. If they don’t file these burdensome reports, they can lose their healthcare.
The needless reports will mostly be filed online. Good luck with that for the thousands of gap folks who don’t have access to the internet. US News rates Idaho 41st in the country for internet access. Arkansas, which ranked 50th in US News, experienced substantial reporting problems when it imposed a work requirement. Many gap folks who were fully employed lost their medical care because they could not navigate the reporting requirement. Talk about a red tape nightmare.
A federal court in Arkansas struck the Arkansas work-reporting requirement down as violative of the Medicaid law. A state can get a waiver for a variation in its Medicaid program if the variation serves the purpose of the Medicaid law. That purpose is to assist low-income people to get medical services. The court ruled that there was no evidence the work requirement served that purpose. In fact, it did just the opposite, depriving them of health coverage.
Courts in Kentucky and New Hampshire have also struck down so-called work requirements as being in violation of the Medicaid law. It is likely the Idaho reporting requirement would also be stricken if the federal government were to improperly grant Idaho a waiver for its work requirement. The suit would provide public-minded lawyers yet another opportunity to get an award of attorney fees for challenging an unwise state law.
The Idaho Legislature provided a fallback in case a person failed to file a proper work report. Rather than totally losing coverage, the person would be liable for a co-pay. I don’t see how that could serve the purpose of the Medicaid law and suspect that it would not suffice to keep the reporting requirement from being invalidated by a court.
Take the time to let Idaho’s public servants know that the state’s deregulation process should extend down the financial ladder to those who are working hard at low-paying jobs that do not provide health coverage. The voters did not want this obnoxious requirement and it should be stricken as an impediment to providing the medical care that folks in the Medicaid gap need.
Jim Jones is a former Idaho attorney general and a former Idaho Supreme Court chief justice.