When I drafted my post on the House Budget Committee’s plan, I discovered that its impacts on affordable health care had too many interlocking parts to fit. So here, as promised, is a followup.
I’ve already mentioned the not-new plan to convert Medicaid to a block grant. But there is something new — a work requirement. State flexibility notwithstanding, able-bodied adults couldn’t qualify unless they were gainfully employed, actively seeking work or participating in a job training program.
Now, this may sound reasonable. But it isn’t — for three reasons. Two we’re already familiar with from the plight of able-bodied adults without dependents who will soon lose their SNAP (food stamp) benefits.
There aren’t enough jobs they can qualify for. There aren’t enough slots in training programs for all the jobless either. And states have no obligation to provide them. No evidence they’d have to for Medicaid — or get any funds for training, as they can with SNAP.
The third reason calls for a look beyond the block grant. The House budget plan would (surprise!) repeal the Affordable Care Act.
This would, among many things, deny a growing number of states and the District of Columbia the federal funds they counted on to cover a large share of the costs they incur because they expanded their Medicaid programs.
They’d lose a total of about $2.1 trillion over the upcoming 10 years. So it’s reasonable to expect they’d revert to their pre-ACA eligibility standards — or something much like. Basically, this would mean that the work requirement would apply to only very poor pregnant women and parents.
Studies of families in the Temporary Assistance for Needy Families program tell us that many of those parents face formidably high barriers to work — some that are also barriers to regular participation in a job training program. Seems they’d go hungry.
Many Medicaid recipients do work, however. Those with incomes at or above 100% of the federal poverty line could buy health insurance on an exchange — if the ACA were still intact. But without it, they’d have no subsidy to help pay the costs.
Other House committees have already passed bills within the framework of the Budget Committee’s attack on the ACA. So yet one more post to come on how key House Republicans would save money at the expense of their constituents’ health, the states they represent or both.