Red Tape: The Next GOP Plan for Gutting Health Care

Thanks to last year’s grassroots uprising, Republicans in Congress have signaled this month that they don’t have the appetite for another bruising legislative fight to repeal the Affordable Care Act or gut Medicaid. If that holds true, it’s great news for women. But that doesn’t mean we can breathe a sigh of relief quite yet.

With the blessing of the Trump administration’s Center for Medicare and Medicaid Services (CMS), a number of red states are already attempting a backdoor attack on Medicaid coverage under the guise of “getting people back to work.” But few people understand what “work requirements” really mean in practice—and who wants to oppose helping people get back to work?

In reality, the overwhelming majority of adults with Medicaid are already either working or can’t work. As the Center on Budget and Policy Priorities notes [see chart], the majority already work, are too sick to work, are going to school, are retired or taking care of family members, or are already actively looking for work and can’t find it. 

Work requirements won’t change those circumstances, but the red tape associated with providing proof of employment, getting doctor’s notes, and filling out stacks of additional paperwork will cause thousands of working people to lose coverage.

As the New York Times recently reported, “a large body of social science suggests that the mere requirement of documenting work hours is likely to cause many eligible people to lose coverage, too.”

This makes perfect sense, particularly for families already struggling simply to survive. After working a physically demanding job as a home health aide or factory worker, or taking care of an aging parent, after working a part-time job and going to school, or managing a debilitating physical or mental health condition, a stack of burdensome paperwork from the state can be the last straw. As the article notes, “these [administrative hurdles] may be especially daunting for the poor, who tend to have less stable work schedules and less access to resources that can simplify compliance: reliable transportation, a bank account, internet access.”

From a public health perspective, it makes little sense to deny coverage that helps prevent the spread of disease, allows the mentally ill to access care, and ensures that family members are able to care for individuals who might otherwise require more costly services like nursing homes.

But as our joint initiative Raising Women's Voices noted in a 2016 research brief, the consequences for women, people of color, and LGBTQ people would be particularly severe. While women and men have had roughly equivalent unemployment rates post-Great Recession, women are far more likely to work part-time, making them vulnerable to the kinds of hourly requirements that some states want to impose. In 2014, for example, women accounted for 66% of the part-time work force and only 41% of the full-time workforce. Likewise, since the 1940s, the unemployment rate among African Americans has been consistently double that of white Americans.

Work requirements also have serious consequences for LGBTQ people, who may disproportionately fall within the category of “able-bodied adults without dependents,” which work requirements often seek to target. In states like Kentucky and Indiana, where work requirements were just approved, there are few or no workplace protections for LGBTQ people. In other words,  LGBTQ people are subject to work requirements, while also facing discrimination that keeps them from being hired, or causes them to be fired.

So, if work requirements do little to help people get back to work and primarily punish people who are already working or who can’t work, why are some states pushing for them? It is a deeply cynical attempt to cut costs and rollback the social safety net. In its application to CMS, Kentucky itself predicted that its burdensome new red tape would cause 100,000 people to lose their coverage over the next five years, saving the state money.

For conservative states looking to do what Congress couldn’t, these red tape barriers to access aren’t a nasty side effect, they’re the whole point of the “cure.”

Sarah Christopherson, MA, is the Legislative Director for the social justice campaign, Americans for Tax Fairness, and the NWHN’s former Policy Advocacy Director. Her 10 years working for Congress and her deep knowledge of health policy and consumer protection make her the NWHN’s issue area expert on federal health reform implementation and defense, drug and device safety and efficacy, and sexual and reproductive health.

Read more from Sarah Christopherson.

The continued availability of external resources is outside of the NWHN’s control. If the link you are looking for is broken, contact us at [email protected] to request more current citation information.