Updated 10 minutes ago
The state House on Tuesday advanced a bill that would force “able-bodied” adults enrolled in Medicaid to work at least 20 hours a week or complete job training programs to retain their health insurance coverage.
The proposed legislation — House Bill 2138 — cleared the House floor on a 115-80 vote. All but five Republicans and just four Democrats voted to send it to the state Senate.
Its prime sponsor, Fayette County Republican Matthew Dowling, touted the bill as a way “to help people out of poverty and reliance on the government for aid.”
But critics — including health care patient advocates and Democratic Gov. Tom Wolf — dismiss the effort as a President Trump-backed attempt by a growing number of GOP legislature-controlled states to scale back on Medicaid programs as federal attempts have faltered to repeal the Affordable Care Act altogether.
“We’re calling on the Senate to reject the efforts put forward by the House today, and we’re calling on Gov. Wolf to once again veto legislation that would do more harm to individuals than it would to help them,” said Antoinette Krause, executive director of the Pennsylvania Health Network Access advocacy group in Philadelphia. “Instead of spending millions of dollars in state resources to throw people off health insurance coverage, lawmakers should be looking for ways to reduce barriers to employment, especially in rural areas outside of Pittsburgh.”
Wolf did not go so far as to say he would veto H.B. 2138, but he said through a spokesman Tuesday night that he opposes the bill and will protect vulnerable populations “from these Republican political attacks.”
“Pennsylvania House Republicans are continuing their efforts to gut Medicaid and kick people off their health insurance, while also spending hundreds of millions of taxpayer dollars to create unnecessary red tape and bureaucracy,” Wolf spokesman J.J. Abbott said in a statement.
Specifically, H.B. 2138 directs the state Department of Human Services to draft a waiver seeking approval by the federal government to implement the Medicaid-related work requirements. Medicaid disbursements come from a combination of federal and state funds.
The Trump administration — which granted permission for states to do so in January — has approved three such waivers so far, in Indiana, Kentucky and Arkansas. Seven others have requests pending before the federal government.
“This is not a back-door attempt to do anything by the Trump administration or by the General Assembly of the commonwealth,” Dowling said. “This is simply our attempt to put able-bodied people to work or to assist them in training programs because we know that work is the clearest line to help propel people out of poverty.”
Nathan Benefield, vice president of the Commonwealth Foundation, a free market think tank in Harrisburg, lauded the proposed legislation as “a major step towards creating a clear and permanent pathway to independence for thousands of Pennsylvanians.” He argued the current Medicaid system “discourages work rather than promoting it.”
Under H.B. 2138, healthy adults on Medicaid must have at least a part-time job, complete 20 weeks or more of job training or complete 12 job training-related activities in a month.
Exemptions from the work requirements would apply to the following types of people:
• High school students;
• People who receive temporary or long-term disability benefits;
• People under age 19 or older than 65 (the age at which most people qualify for Medicare);
• Pregnant women;
• Primary caregivers to children under 6;
• Primary caregivers to the terminally ill;
• Social Security Income beneficiaries;
• Individuals who live in mental health institutions or correctional institutions; and
• Individuals experiencing a serious or temporary medical condition that prohibits work or a crisis, including domestic violence or a substance abuse disorder.
Critics such as Krause fear that even people who meet the work requirements or exemptions could lose their coverage while having difficulty completing the necessary paperwork to prove it.
The Department of Human Services, which opposes the bill, estimates that the first year of implementing it could cost the state as much as $800 million.
“The department shares the goal of helping the individuals we serve become self-sufficient, but we must ensure that people can access the health care they need to get and stay healthy to find work,” DHS Secretary Teresa Miller said in a statement. “Instead of punitive proposals that could leave people without health care and basic supports, we should focus on how we break down barriers for people to get good paying jobs and keep them.”
Dowling dismissed the $800 million first-year price tag as “grossly exaggerated,” saying he would expect the Wolf administration to work to ensure that the ensuing regulatory enforcement isn’t overly burdensome.
“The taxpayers are willing to make a small sacrifice in tax dollars to ensure that those who truly need medical aid are the ones that are benefitting from their taxes,” Dowling said.
DHS officials could not immediately provide figures of how many people could be impacted should the bill become law.
Fifty-one percent of the state’s able-bodied Medicaid recipients do not work, according to Dowling’s office.
Wolf vetoed a bill last fall that contained a similar requirement.
Dowling said his latest bill is a simplified version that includes more exemptions, such as caregivers of people in hospice care.
“I think it will clear the Senate,” whose leaders have expressed “general support of the idea,” Dowling said.
“I’m not a proponent of running a bill just for show or political antics,” Dowling said. “In running this, I truly do hope that it becomes law and that the governor will see the amount of work that we did to build in exemptions.”
Medicaid, originally designed for poor families and the severely disabled, has become the country’s largest government health insurance program, helping 1 in 5 people.