JUANA SUMMERS, HOST:
Tying health insurance to work for roughly 80 million low-income Americans is a popular idea among Republicans. In fact, earlier this year, Republicans introduced a bill to create a national work requirement. In the meantime, states are now reviving plans to require adults to prove they are working in order to get Medicaid. Alex Olgin reports that has some Medicaid recipients concerned.
ALEX OLGIN, BYLINE: Summer Neal (ph) needs a lot of medications. The 31-year-old has a chronic disease called lupus that causes her immune system to attack itself.
SUMMER NEAL: I do get sick a lot because of the lupus. Someone can have a cold, and it'll turn into the flu for me, or pneumonia.
OLGIN: Any hiccup in her Arkansas Medicaid coverage can be catastrophic. That's what happened this December when she says there was a paperwork error. Neal was picking up meds to keep her pain and swelling at bay when the pharmacist told her she no longer had insurance. The tab without coverage was over a thousand dollars.
NEAL: I about lost my Jesus, OK? Like, I love the Lord, and I about lost all of it. I was like, there is no freaking way - but in more colorful words.
OLGIN: She says she left empty-handed and started to spiral.
NEAL: If I don't have a steroid to keep this inflammation down, the amount of pain that I am in is almost unbearable.
OLGIN: Neal ended up delaying her rent to cover the cost of medication. The error was eventually fixed, and Neal now has Medicaid coverage again. If Neal's illness got worse and she had to stop working as a manager at a pizza restaurant, she's worried those high bills could become normal. That's because Arkansas Governor Sarah Huckabee Sanders proposed a change to how Medicaid works in the state. Now if you're a single adult making about $20,000 a year or less, you can qualify for Medicaid. These rules would add another test - you have to show you're working.
(SOUNDBITE OF ARCHIVED RECORDING)
SARAH HUCKABEE SANDERS: Most Arkansans work hard to pay for their health insurance, but many of these healthy adults don't work at all and receive it for free. That is not how the system should work.
OLGIN: Arkansas is waiting for the federal government to approve the rule change, so are Ohio and Arizona. But several studies show that more than 90% of eligible adults on Medicaid are already working, or they're exempt from the requirement because they have disabilities or are in school or are caregiving. And seven years ago when Arkansas did this under the first Trump administration, many of those people lost coverage anyways because they didn't follow the complicated monthly process for reporting work. And fixing that became Trevor Hawkins' full-time job.
TREVOR HAWKINS: It was overwhelming. It was my entire day.
OLGIN: He's an attorney with Legal Aid of Arkansas, an organization that helps low-income people with health care and housing issues.
HAWKINS: I was just on the phone trying to help folks through these procedural issues, jump through those hoops.
OLGIN: He also says research found it didn't lead to people working more.
HAWKINS: And so it's a bad investment. It costs the state a lot of money to administer and does not lead to any increase in employment.
OLGIN: Gideon Lukens is a senior fellow at the Center for Budget and Policy Priorities (ph).
GIDEON LUKENS: I would say that work requirements are just another way to cut Medicaid.
OLGIN: The Congressional Budget Office estimates that if all states had these Medicaid work rules, it could save over a hundred billion dollars over 10 years. But that savings comes at a great cost, says Lukens - people being kicked off Medicaid.
LUKENS: So when you have people losing coverage, yes, you do pay less money, but you also have extreme hardship.
OLGIN: When Arkansas changed the Medicaid rules before, it got thrown out by a judge who said it was illegal and contradicted the purpose of Medicaid, which is to provide a safety net for low-income people. Arkansas has rewritten the rules to try and get around this ruling, but it remains to be seen whether the courts allow it this time. For NPR News, I'm Alex Olgin. Transcript provided by NPR, Copyright NPR.
NPR transcripts are created on a rush deadline by an NPR contractor. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.