If Maine ever joins the ranks of states that have extended Medicaid coverage to low-income adults — something voters last year decided they favored — there are benefits in store.
A recent study from the Government Accountability Office compared low-income residents’ access to medical care in states that had expanded Medicaid coverage under the Affordable Care Act and in states that hadn’t. The results aren’t so surprising, but they offer another data point to prove the state’s voters made the right decision last year.
In the GAO’s review of data from the 2016 National Health Interview Survey, the office’s analysts found that low-income residents in states that hadn’t expanded coverage were more likely to encounter financial barriers to medical treatment and were more likely to have put off medical care because of its cost.
Forty percent of low-income adults in non-expansion states reported having unmet medical needs in the 2016 survey, compared with 26 percent of the lowest-income adults in states with expanded coverage. And a fifth of low-income adults in non-expansion states reported financial barriers to care, compared with 9 percent in expanded-coverage states.
In states with expanded coverage, low-income adults were also more likely to say they had a usual place where they received medical care. Eighty-two percent of low-income adults in expansion states reported that they had a medical home, compared with 68 percent of their counterparts in states without expanded coverage.
Arkansas has been one of those states with expanded coverage since states first became eligible for federal funds to extend coverage to low-income adults. So, low-income adults in that state are among the population of low-income adults who are more likely than their counterparts in non-expansion states to have an established place to receive care and less likely to encounter financial barriers that prevent them from actually seeking care.
But those currently in charge in Arkansas are detracting from the advantages the state’s Medicaid expansion has brought to its low-income population. That’s because Arkansas is the first state that’s been able to move ahead with a policy that requires that certain adult Medicaid recipients comply with work requirements in order to retain their health coverage.
Maine is among a handful of states awaiting the federal government’s approval to impose similar requirements.
But the early data in Arkansas, which implemented the requirement in June, show that 4,353 lost their health coverage in the first months after the requirements took effect. Medicaid recipients there have to log their work hours through an online portal, even though Medicaid recipients are more likely than others to lack internet access. Others worry that the work requirement policy has been so complicated that recipients didn’t understand state notices describing what they had to do to maintain coverage. It’s an illustration of how imposing work requirements adds another layer of administrative complexity to a government health care program.
It’s also a sign that the policy’s main effect is to deprive people without means of health coverage — coverage that can help them improve their health enough to work.
In Maine, the LePage administration has wanted to travel the same path, and it has done so since the Trump administration invited states to propose imposing work requirements. Former Health and Human Services Commissioner Mary Mayhew was instrumental in assembling Maine’s work requirement proposal before she left the administration to run for governor.
Now, Mayhew is in charge of Medicaid nationally. It’s clear her priorities align more with the results of Arkansas’ disastrous work requirement experiment than with Medicaid’s statutory objective — “making medical assistance available” to the populations policymakers have determined need help with health coverage.
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