Editorial: Work requirements led to loss of health insurance for 18,000 Arkansas residents. Many didn’t realize they had no insurance until they sought care or were sent bills after receiving care.

Every once in a while you get to see what happens when a bad policy idea becomes reality. Look no further than Arkansas, which enacted work requirements for Medicaid recipients. Iowa’s Republican lawmakers and governor should take an especially close look. 

In 2018, Arkansas embarked on an experiment to become the only state to fully implement Medicaid work requirements. Medicaid, funded by federal and state governments, provides health insurance for low-income Americans and ensures health providers who treat poor patients are compensated.

Arkansas required many residents covered by an Affordable Care Act expansion to perform at least 80 hours per month of work, volunteering, job training or other activities.

What ensued was exactly what should have been expected: confusion, more paperwork, increased bureaucracy, court fights and people losing health insurance. 

A federal judge eventually blocked Arkansas’ requirements, noting the state did not adequately consider the potential to cause people to lose coverage. The Trump administration, which has repeatedly demonstrated it is no friend of Medicaid or vulnerable people, is appealing that decision. 

Amid all this, an estimated 18,000 people lost health insurance — largely because they were confused about or unaware of new requirements. Many didn’t realize they had no health insurance until they sought medical care or were sent bills after receiving care.

Iowa needs to learn from the disastrous consequences in Arkansas. 

Earlier this year the GOP-led Iowa Legislature jumped on the misguided work requirement bandwagon and supported legislation with language that looks a lot like what Arkansas implemented. It directed the Iowa Department of Human Services to seek federal permission to require “able bodied” Iowans to engage in work, community activities or be enrolled in school about 80 hours a month. 

(Remember, most of these same part-time lawmakers receive taxpayer-paid insurance to cover health care costs for them and their families). 

The nonpartisan Legislative Services Agency cautioned Iowa lawmakers that more than 70,000 Iowans would be affected. The additional work for state employees, hiring more staff, gathering information on beneficiaries and other newly created bureaucratic issues were estimated to cost $5 million the first year and nearly $12 million the second. 

Plus, of course, there would be the expense of defending the state against inevitable lawsuits. 

Arkansas has no evidence to show the work requirements increased employment. It does, however, have thousands more people without insurance and many health providers, including hospitals, not being compensated.

Will Iowa’s GOP lawmakers learn from this? Will they finally understand that Medicaid gets people connected with the health care they need to be well enough to hold jobs?

If you are mentally ill, prescription drugs may be the key to securing and maintaining employment. People suffering from chronic pain, shortness of breath, depression, diabetes, drug addiction or numerous other problems need care in order to pursue opportunities, including education and work.  

Besides, work requirements would not apply to a majority of Medicaid recipients. About half of enrollees in Iowa are children. Other big slices: the elderly in nursing homes, and people with disabilities whose work options may be limited.

The majority of able-bodied adults on Medicaid already have jobs, and many of them work full-time. But they’re still poor enough to qualify for Medicaid.

Iowans have already been put through the wringer with the disastrous privatization of Medicaid under GOP leadership. They’ve had to navigate changes in coverage, some have lost in-home care and others continue to be thoroughly confused. Health providers have reported not being reimbursed for services.

The last thing this state needs is the confounding mess and the loss of health insurance that work requirements would bring.

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