Dejuan Eppenger was born to play basketball.
Or, at least, he was born from playing basketball, as his mother went into labor on the court making a jump shot. The 19-year-old from Pontiac is a full-time student athlete on a scholarship at Madonna University in Livonia, just two years shy of receiving his degree in business administration. Someday, he hopes to open his own nursing home with some of his friends from college.
Eppenger said he won’t let anything get in the way of his dreams. Even if that means living without healthcare.
He’s one of up to a million people in Michigan who might be affected by legislation that require Medicaid recipients to work. Legislation passed by the state Senate and pending in the state House would require Michigan’s Medicaid recipients to work 29 hours a week. They would lose coverage for a year if they fail to document their work activity, a condition that opponents say is the most stringent devised by the three states that already have the requirement.
Though the legislation would exempt the disabled and the elderly from working, widely varying estimates from opponents are that it could potentially affect health coverage for anywhere from 150,000 to a million people, and lead to increased emergency room visits and skyrocketing healthcare costs.
Medicaid and Healthy Michigan enrollments vary widely across Michigan’s 83 counties.
In affluent Oakland County, about 11 percent of the county’s 1.2 million residents receive health care through Medicaid or Healthy Michigan. In Macomb County, Medicaid provides health services for 16 percent of the population. In Wayne County, the figure is a much higher 28 percent.
Eppenger has been on Medicaid for the past five years and while he doesn’t suffer from immediate illnesses, he has a family history of heart failure.
In December 2017, his insurance was canceled for a short time and he got sick in that period, just a small case of the flu, but the hospital bill was around $870.
“I’m on Medicaid because insurance is expensive, especially being a college student,” Eppenger said. “That bill (without insurance) was massive. I was so stressed out about it. I have to pay for student loans, books, class materials I really need.”
If the 29 hour a week work requirement were to pass, Eppenger would have to choose between continuing with his degree or finding a full-time job. His scholarship requires him to be a full-time student taking 12 credit hours while he works as a student assistant on campus for about 16 hours a week.
Eppenger said even though it’s scary, he’s already made his choice.
“Honestly I would just go without healthcare. I’m already in the process of graduating,” Eppenger said. “It’s a risk, because I’m an athlete, anything can happen on the court. If I needed medical assistance and couldn’t afford the treatment to get better, I’d have to give up on basketball too. I wouldn’t want to, but I’d have to.”
Paying for his degree, trying to support himself with the help of family and friends, has already put a financial burden on Eppenger. He said if this the requirement were to pass, that extra burden would be overwhelming.
“I just feel like sometimes, when it comes to things like this, people don’t think of who is going to be affected, they just think about what’s the ‘right way’ or whatever suites them,”
If the bill passes and is signed into law by the governor, Michigan would be the fourth state to require people receiving Medicaid or the state’s Medicaid expansion called Healthy Michigan – which is health insurance for low income people and families – to work.
Kentucky, Indiana and Arkansas have also passed legislation to allow work requirements, but none have implemented them yet. In Kentucky, at least, legal challenges to work requirements have stopped implementation.
Opponents say Michigan’s attempts to impose work requirements will cost the state up to $30 million.
Work requirements for Medicaid became possible when the Centers for Medicare and Medicaid Services posted new guidance that would allow states to seek federal waivers to make work requirements a condition for coverage.
For those with current medical issues or extensive medical histories, the reality of a work requirements is an emotional one.
In 2008, Karen Schultz Tarnapol lost her job. Then her son needed open heart surgery and she was diagnosed with breast cancer.
“Medicaid paid every dime for both of us,” Tarnapol, an Oakland County resident, wrote in a statement to the state House Appropriations Committee Wednesday.
“As a mother, I was able to concentrate on caring for my sick son, and when I was undergoing treatment, I was not financially burdened with the medical bills and was able to focus on getting well and caring for my kids,” Tarnapol said. “If we didn’t have this insurance our story would have been significantly altered.
“Being on Medicaid and food stamps is not something I wanted to be on, and we are no longer on either program, but it made all the difference in the world when I needed it.”
The American Cancer Society Cancer Action Network estimates more than 56,000 Michigan residents will be diagnosed with cancer this year, and potentially unable to work because of the rigor of treatments.
Most Medicaid recipients who can work are already working, argues Gilda Jacobs, of the Michigan League for Public Policy.
“Lawmakers are disregarding significant evidence that work requirements don’t work,” said Jacobs, a former Democratic lawmaker from Huntington Woods. “We believe Medicaid work requirements will cause problems for all Medicaid recipients. It could result in losing coverage.”
Emily Helene of Southfield, posting to The Oakland Press Facebook page, questioned why the legislation contains a 29 hour a week work requirement.
“Why should whether or not people deserve life saving care depend on how useful they are to society? And why is the metric for “useful to society” working a minimum of 29 hours per week?” Helene asked. “The real question to ask is, is a human being’s life valuable simply by virtue of their being human, or do we have to do something in our lives in order to be considered valuable? We tend to think of children as being innately valuable. Should this change as children become adults?”
Heather Hall is a bone cancer survivor. Between the illness and the treatment she was so sick she couldn’t have worked as required in the proposed Medicaid legislation.
“My treatment was all inpatient,” said Hall, who lives in Sterling Heights on the border of Oakland and Macomb counties. “I was pretty much in the hospital three out of four weeks a month for 13 months. I could not have recovered and been forced to work. When you finish treatment, you’re weak. If you’re forced to return to work, that could be detrimental.”
Recent Medicaid and Healthy Michigan enrollment numbers for March, the latest available, show 1.7 million Michigan residents are covered under Medicaid or Healthy Michigan. Still, that’s 17 percent of the state’s population.
Aviva Aron-Dine, vice president for health policy at the Center on Budget and Policy Priorities; said most of the Medicaid enrollees in Michigan who are already working are employed in low income jobs in places like restaurants where jobs and hours are volatile.
“Especially in northern Michigan, there’s a lot of seasonal workers,” Aron-Dine said. “Many Medicaid enrollees will still experience periods where they’re not working. Many of the people who would get hurt are low income workers who are trying very hard. Locking them out of coverage for a year will worsen health.”
Aron-Dine estimated 46 percent of Michigan Medicaid enrollees would be at risk of losing Medicaid coverage for at least one month during the year.
Groups opposing the Michigan legislation include the Center for Civil Justice, Michigan Protection and Advocacy Services, National Association of Social Workers – Michigan Chapter, American Lung Association, The Arc Michigan, Michigan Health & Hospital Association, United Way for Southeastern Michigan, Elder Law & Disability Rights Section of the State Bar of Michigan, McLaren Health Plan and Henry Ford Health System.
The Michigan legislation remains pending in the state House.