Ohio leaders push to make it harder for poor to get health coverage

By: - September 10, 2021 12:50 am

Gov. Mike DeWine is pictured during a statewide address. Photo courtesy Ohio Channel.

Ohio Gov. Mike DeWine has cast a skeptical eye on regulations for a group the state refers to as “job creators.” But he and Attorney General Dave Yost are pushing for regulations that will make it more difficult for the poor — including those with jobs — to get health care.

DeWine on Thursday announced that he was calling on Yost to sue to overturn President Joe Biden’s decision to invalidate Medicaid work requirements. Former President Donald Trump approved the Ohio work requirement in 2019.

In the Buckeye State, Medicaid covers 25% of the population, so the requirement would affect many.

“Removing a provision that says a healthy, able-bodied individual should be working, looking for work, participating in job training, or participating in a recovery program in order to receive free taxpayer-funded health care is contrary to Ohioans’ values,” DeWine said in a statement that was issued under his and Yost’s names. 

It adds, “Eliminating reasonable requirements discourages people from becoming self-sufficient and only reinforces government dependency. Ohio’s program would offer assistance when Ohioans need it, while providing opportunities for future success.”

The statement didn’t provide any evidence to support those assertions. Meanwhile, there appears to be considerable evidence to the contrary.

For starters, at least before the pandemic, most Medicaid recipients who could work did. 

The non-partisan Kaiser Family Foundation in February reported that in 2019, 63% of non-elderly, non-permanently disabled, adult Medicaid recipients in the United States worked full or part-time. Another 29% were caregivers, in school or ill. That means just 7% who were on Medicaid couldn’t find work or faced a similar challenge.

In addition, the state’s own numbers appear to bely the governor’s assertion. The Ohio Poverty Law Center pointed out that the Ohio Department of Medicaid’s assessment of the expansion population between 2016 and 2018 expansion found that in the absence of a work requirement:

  • 94% of participants “were either employed, in school, taking care of family members,
    participating in an alcohol and drug treatment program, or dealing with intensive physical health or
    mental health illness (many had comorbid conditions).”
  • 84% of employed enrollees reported that Medicaid made it easier to keep working and 75% of unemployed enrollees said the program made it easier to look for work.
  • Employment among the expansion population rose by 6.4 percentage points over the two years.
  • Primary-care visits for the group went up between 2014 and 2017, while emergency room visits went down.

DeWine’s office didn’t immediately respond when asked why — given that most non-elderly Medicaid recipients are working, in school, caregivers or sick — the new rules are necessary. But in a Friday email, Press Secretary Dan Tierney said, “The Ohio work requirement encourages able-bodied individuals to strive for independence and improved health while supporting them as they work toward their goals. Evidence supports a connection between those who are working, volunteering, or learning new skills and improved health outcomes.”

As evidence, Tierney offered a 2018 report by the Buckeye Institute. It estimates big increases in lifetime earnings for people whom the Medicaid requirements would force to work more than 20 hours a week, but aren’t already. It appears to be silent on how large this group would be, while analyses by KFF and the Medicaid department say it would be tiny.

KFF also reports that real-world experience with work requirements shows that they push large numbers out of the government health program for the poor. 

In an analysis of Arkansas’s work requirement, KFF said that in 2018 more than 18,000 — or 25% of those subject to the requirement — saw their benefits cancelled for non-compliance. Of those, just 11% were reinstated the following year.

Focus groups indicated that enrollees were often confused by or unaware of the requirements, had issues creating online accounts or didn’t receive mail related to them because of a lack of stable housing — all problems more likely to beset the poor.

Tierney said it’s not fair to compare the Ohio requirement to another state’s

“Ohio’s reasonable requirements don’t place additional administrative burdens on participants and shouldn’t be compared to other state programs as they are fundamentally different,” he said.

The Buckeye Institute analysis he sent confessed ignorance on the matter.

“This analysis does not estimate the effect of potential Medicaid dropouts as a result of work requirements,” it said. “This is a topic meant for further research.”

KFF also noted that squeezing recipients out of Medicaid is likely to force medical providers to give more care without compensation — costs that everybody else would have to cover. And the organization said kicking people off Medicaid rolls would make people sicker, rendering many unable to work.

With economic disruption from the coronavirus pandemic continuing — and with DeWine ending federal unemployment supplements and an eviction moratorium expiring — critics say the move will for no reason punish vulnerable Ohioans.

Be that as it may, state leaders who were quick to give a corrupt, $1.3 billion bailout to wealthy energy companies insisted that the Medicaid work requirements are needed to help the poor out of poverty.

“The Biden Administration’s decision to withdraw Ohio’s Medicaid work requirement fails to prepare people for a productive life, trapping recipients in a never-ending cycle of dependency and poverty,” tweeted Lt. Gov. Jon Husted. “The idea that Americans can receive free health care at the expense of other hard-working Americans and cannot be asked to complete job training, education or work 20 hours per week undermines the American ethic.”

Husted didn’t immediately respond to a tweet asking to provide data showing that the absence of Medicaid work requirements traps people in poverty. 



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Marty Schladen
Marty Schladen

Marty Schladen has been a reporter for decades, working in Indiana, Texas and other places before returning to his native Ohio to work at The Columbus Dispatch in 2017. He's won state and national journalism awards for investigations into utility regulation, public corruption, the environment, prescription drug spending and other matters.