Despite being a doctor with progressive health conditions, it wasn’t until I started working on Medicaid policy and financing in Colorado that I realized we are thinking about Medicaid the wrong way.
Medicaid is a health insurance program, similar to the commercial plans available on the health insurance marketplace or through an employer. With commercial health insurance, you pay a monthly fee just to keep the insurance company in business, and then you have co-payments or deductibles based on the health services you use. Commercial health insurance plans typically spend 20%-25% of the money you pay them on administrative costs.
Medicaid is run as one of the multiple functions of the Colorado Department of Healthcare, Policy, and Financing (HCPF), which is funded by the state budget every year. The cost of running Medicaid in Colorado is only about 3% of the total amount spent, and the expense Medicaid enrollees generate are mostly based on the health services they need and access. If a Medicaid member doesn’t need care, they only cost the system a minute fraction of the general overhead of administering Medicaid.
Like commercial health insurance, Medicaid doesn’t cover things like cable, video games, or money for other non-health-related expenses. The mythical 29-year-old guy who doesn’t work and plays on the computer all day long isn’t living off Medicaid. It’s also unlikely this gamer has a regular need for health-care services, and thus costs the state very little to keep on Medicaid. Implying they are unmotivated won’t help them get a job, and kicking them off Medicaid won’t even make a dent in spending.
However, the young unemployed person without kids who is seeing their doctor frequently may very well have a chronic health issue. Without access to health care to manage their condition, it can be hard for someone with a chronic illness to find a job they are able to do, and then to stay employed. Taking away Medicaid or making it harder to qualify doesn’t mean someone no longer needs health care, and requiring them to be working in order to have Medicaid leaves them in a catch-22, where they have neither a job or health care.
Multiple studies have shown that 92% of people enrolled in Medicaid are either working, disabled or have other responsibilities — such as caregiving or going to school. Work requirements for Medicaid were tried in Arkansas and Georgia, but the outcome didn’t benefit Medicaid members or their states. In Arkansas, the savings from having work requirements came because over 18,000 (25%) of the Medicaid enrollees that were subject to the requirements, lost coverage. Most still met the eligibility criteria and the work requirements for Medicaid, but were kicked off due to problems accessing and using the systems that were created to report work or report being exempted from the requirements. These systems also cost tens of millions of dollars to design, build, and implement — money that could have been used to pay for care for people on Medicaid.
Keeping this in mind, Medicaid is expensive because health care in America is expensive. The only way to significantly decrease federal spending is by decreasing the number of people who are on Medicaid. Most people on Medicaid want to work, if they aren’t already, and adding work requirements and threatening to take away their health coverage isn’t going to help. Not having health insurance doesn’t mean someone won’t need health care, but does make it likely they won’t have the ability to access care or pay for it when they do.
Dr. Kimberley Jackson grew up in New Jersey, and graduated from Rutgers University with a B.S. in Biomedical Engineering. She attended osteopathic medical school in New Jersey, and graduated in 2008. Dr. Jackson was a family medicine physician in Pueblo until 2012, when symptoms related to Ehlers Danlos Syndrome forced her to leave practice. She began working with the Colorado Cross-Disability Coalition (CCDC) in 2013, on disability rights and health-care access in Colorado. She serves on multiple boards and committees for Colorado Medicaid, and is vice chair of the Colorado Hospital Affordability and Sustainability Enterprise board – which manages the Medicaid Provider tax in Colorado. In 2021, she was appointed chair of the Colorado Prescription Drug Affordability Advisory Council, which works with the Colorado Prescription Drug Affordability Board to make medications more affordable for Coloradans. She is also board secretary for CCDC.
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