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Member Research & Reports

Member Research & Reports

Rutgers Faculty Challenges Assumptions About Medicaid Waivers

Rutgers School of Public Health faculty and director of the health systems and policy concentration, Dr. Michael K. Gusmano, reviews efforts to impose work requirements and more considerable out-of-pocket costs on Medicaid recipients, in a new paper published in Health Progress.

In light of the failure of the 115th Congress to repeal the Patient Protection and Affordable Care Act (ACA), the Trump administration has used executive actions to reduce the reach of the ACA. As part of that strategy, the administration has encouraged states to submit Medicaid waivers that include work requirements and greater out-of-pocket payments for some adult Medicaid beneficiaries. Although these efforts have been challenged in federal court, such provisions have been implemented and continue to be implemented in several Medicaid-expansion states.

In his latest paper, Dr. Gusmano raises several concerns about imposing work requirements on Medicaid beneficiaries, including an unclear correlation between employment and health; existing evidence that shows those who perform shift work or work jobs with high levels of insecurity suffer from poorer health; and eliminating health insurance from those who are already unemployed could further undermine their health status.

Many economists argue that health insurance leads to the inefficient consumption of healthcare and that higher out-of-pocket costs will force individuals to act more responsibly when seeking health services. However, implementing such a measure would have the most impact on low-earning or unemployed Medicaid beneficiaries, who don’t have the means to pay for healthcare in the first place.

“Imposing both higher out-of-pocket costs and work requirements on Medicaid beneficiaries further supports the negative assumptions about social programs and their recipients,” comments Dr. Gusmano who is also a Hastings Center Scholar. “Rather than improving the health of poor people, these policies will reduce health insurance coverage, harm vulnerable populations, and undermine public health.

“Challenging Assumptions about Medicaid Waivers,” was recently published in Health Progress.