Lawmakers look to cut Medicaid by ramping up administrative hurdles
Posted on January 17, 2025 at 4:50 PM by Anne Discher
In 2013, Iowa was among the first states to take up the federal option to expand Medicaid to low-income adults. In doing so, we cut our state’s uninsured rates and made it possible for thousands of Iowans to see a doctor, get medications, and go to the hospital without fear of choosing between their health, buying groceries or paying the rent.
With an incoming administration likely willing to approve state plans the Biden administration wouldn’t, the Governor and some lawmakers now want to pare back Iowa’s adult coverage gains. They would add new layers of red tape by requiring Iowa Medicaid adult enrollees (we haven’t yet seen a bill, so we don’t know exactly how many) to report work hours to the state.
The truth is, we all agree on the value of helping people get into good jobs. Work is important. But ramping up red tape to cut people off their health insurance simply isn’t the way to get there.
The reality is that most people on Medicaid who can work do so — but they’re working low-wage jobs with changing hours and no benefits. And most of those who aren’t working are dealing with serious health challenges or caregiving for loved ones that make work impossible. And like many Iowans with low incomes, folks on Medicaid are more likely to move frequently and have unreliable internet access — challenges that make carefully tracking paperwork especially difficult.
The experiences of other states are instructive:
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When Arkansas implemented similar requirements during the first Trump administration, over 18,000 eligible people lost coverage because they couldn’t jump the required bureaucratic reporting hurdles, and the state saw no increase in employment.
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In Georgia, where the state recently expanded Medicaid for some low-income adults and established reporting requirements, 90% of expansion spending has gone to hiring pricey consultants like Deloitte and to creating complex reporting systems — and only a few thousand people have successfully enrolled.
It’s worth noting that Iowa HHS is not expected to meet a July 2025 deadline to launch information systems for a set of public assistance eligibility requirements lawmakers approved two years ago. How ready is it to regularly track work hours for thousands of Medicaid members? How much will it cost?
Helping people who can work find good-paying jobs is good for families and good for Iowa's economy. But taking health coverage away from people who don’t meet a rigid requirement to report work hours to the state won’t achieve that goal. It will just make their lives harder.
Learn more:
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Adrian’s story. This News Hour report from 2018 — during the first Trump administration — is a good, if painful, reminder of what losing Medicaid mean for people’s lives. Worth a watch.
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Three-fourths of adults hold favorable views of Medicaid, according to a national poll released today by KFF. That includes 63% of Republicans, 81% of independents and 87% of Democrats. Just 13% said reducing funding for Medicaid is a top health-care priority.
Share of U.S. adults with a favorable view of Medicaid
Source: KFF
Categories: Health, Jobs & labor, Safety net & work supports