Hundreds of thousands of New Yorkers could lose health coverage if Congressional Republicans move forward with a proposal to add work requirements under the Affordable Care Act’s Medicaid expansion.
Between 743,000 and 846,000 residents across the state could lose coverage next year if the plan – which was part of a 50-page list of potential cuts circulated by the House Budget Committee in January – is included in the budget reconciliation package, according to an analysis of census and Medicaid data by the Urban Institute, a Washington D.C.-based think tank. New York would be the second hardest hit state, after California, according to the analysis modeled on outcomes in states that have applied similar measures.
The cuts would amount to a collective loss of millions of dollars in coverage of some of the poorest New Yorkers, forcing more people to forgo emergency and preventative care. The outcome would likely be a strain on safety net hospitals, where many of the newly uninsured would seek care, often as a last resort, along with the state’s Medicaid coffers, experts say.
As part of the Affordable Care Act, states were incentivized to expand Medicaid to include adults ages 19 to 64, making up to 138% of the federal poverty level with no work requirements. Today, Medicaid covers close to half of the city’s 8.5 million residents.
Most people subject to work requirements are exempt either because they are working, looking for work, caregiving or have a physical or mental health issue that prevents them from working, according to the study. Though 9 out of 10 recipients aged 19 to 55 fall into that category many will likely lose coverage anyway because of low awareness, inability to navigate the compliance system and difficulties documenting cash employment, said Katherine Hempstead, senior policy adviser at the Robert Wood Johnson Foundation, which funded the Urban Institute study and a series of similar ones on other proposed cuts.
“The way that work requirements ‘save money’ is basically by mistakes, primarily,” Hempstead said.
The January list, first reported by Politico, says little about how the cuts would work, except that they would apply to “able-bodied adults without dependents” with exceptions made for pregnant women, primary caregivers, people with a disability that prevents them from work and full-time students. The measure would save an estimated $100 billion nationwide over ten years, according to the document.
The administrative burden of implementing the policy is significant and could cost tens of millions of dollars from the state’s Medicaid budget, said Cristina Freyre Batt, senior vice president of the Healthcare Association of New York State, a hospital trade group that opposes work requirements for Medicaid. The state will have to make that up either by raising taxes, reducing Medicaid coverage or lowering reimbursement rates to providers, she said.
“People will still need access to health care and they are going to seek it out…at a point that is going to be more costly for the system overall and worse for health outcomes,” she said. “We’re really looking for a solution to a problem that does not exist.”
