Gregory Tyrone Bryant left his last stable job at a meatpacking factory to fight a cocaine addiction eight years ago. When he returned to the workforce a year later, his options were limited: mostly temporary jobs without healthcare benefits.
Since 2014, he’s relied on medical coverage offered under Arkansas’ expanded Medicaid program for low-income households. It proved essential last June when he needed surgery to replace his right knee, and covers costly prescriptions for acid reflux and high blood pressure medicines.
Bryant, 48, had been out of work again for more than a year until late last month, when he got hired as a janitor in his local school district. On a 90-day probation period, he hopes the job will turn into full-time work. He had been living off a monthly short-term disability check from his last job assembling rear axles for Toyota cars. There’s not much on offer near his home in Earle, Arkansas, population 2,000.
If his job doesn’t pan out, his unemployment will pose a new threat to his healthcare coverage.
In June, Arkansas became the first U.S. state to require that many able-bodied Medicaid recipients do some combination of work, volunteer, job training or schooling a minimum of 80 hours each month to keep their benefits, a sweeping shift in healthcare rules that will soon be followed by Indiana and New Hampshire. Another eight states await approval from the Trump administration for similar work requirements that will fundamentally refigure the 50-year-old program.
Republican governors and lawmakers say the work requirements are vital to help manage their ballooning Medicaid costs, particularly in states like Arkansas that expanded the program under former President Barack Obama’s Affordable Care Act. The goal, they say, is to encourage healthier residents to return to the employment track, or seek better jobs that could eventually bring benefits.
“It’s an element of individual responsibility that if you’re able-bodied … you should be contributing in some fashion,” Arkansas Governor Asa Hutchinson said in an interview. “You always want people to move up to make more wages and have a higher income so they don’t even have to qualify for Medicaid.”
Yet the new measures have triggered fears that thousands could lose their Medicaid benefits, putting already vulnerable laborers deeper into the hole. The changes are also forcing insurers to hustle to help clients navigate the maze of paperwork they must complete to keep benefits intact.
And Kentucky’s plan, poised to become the second to take effect, hit an abrupt halt last month when a federal judge blocked the law – deeming the Trump administration’s approval “arbitrary and capricious.” The U.S. Department of Health and Human Services never fully considered whether Kentucky’s plan will provide medical assistance to residents, U.S. District Judge James Boasberg ruled. The state said it will amend its proposal in hopes of clearing the legal hurdle.
In Kentucky alone, nearly 100,000 more people could be eliminated from Medicaid within five years than without the new measures, state estimates say. Kentuckians who do not work 80 hours in any one month or fail to pay new premiums will be locked out for six months; beneficiaries could take a health or financial literacy course to reactivate coverage.
In Arkansas, those who fail to meet the work requirements for any three months will be locked out of health insurance for the remainder of the year.
In meetings with state legislators, the Arkansas Hospital Association has expressed concern that many affected by the rules will either not be able to find work, or won’t be able to meet online filing requirements because they live in rural areas without reliable Internet access.
“We’re worried about people losing coverage who should not be losing their coverage,” said Bo Ryall, the group’s president.
As he visited a local health clinic for severe back pain, Bryant pondered that question. “I thought the insurance was to help us, even if you’re working, even if you’re not working,” he said. “It was supposed to help us, not pull us down.”