GOP lawmakers set up roadblocks to voter-approved Medicaid expansion

Tennessee seeks to be first to turn Medicaid into block grant program

Many residents in three deep-red states rejoiced last fall when voters approved Medicaid expansion, circumventing the objections of their elected representatives.

But the victories in Utah, Idaho and Nebraska — which would have extended coverage to tens of thousands of residents in each state under the Obamacare provision — have proven short-lived.

This week, Idaho’s GOP lawmakers and governor joined their peers in Utah and Nebraska in slapping work requirements and other restrictions on access to Medicaid. Idaho legislators had considered bills with less stringent measures, but ultimately rejected those.

“We must encourage self-sufficiency among those receiving public assistance,” Idaho Gov. Brad Little, a Republican, wrote to the president of the state Senate upon approving the bill.

The moves demonstrate the enduring resistance among Republicans to adopting programs tied to the Affordable Care Act, even when voters themselves explicitly ask for them.

In all three states, certain Medicaid recipients, primarily working-age, non-disabled adults without dependents, will have to work or engage in other activities at least 20 hours a week to maintain their benefits. The repercussions of not doing so vary by state. In Idaho, enrollees are kicked off the program for at least two months. Nebraska’s poor lose access to so-called prime coverage, which includes dental, vision and over-the-counter medication benefits.

The states also made it more difficult for those just above poverty level to access Medicaid, even though Obamacare makes eligible those earning up to 138% of the poverty line, or about $12,500 for an individual. Utah is restricting coverage to those in poverty. In Nebraska, residents just over poverty must opt into Medicaid — otherwise, they default into polices on the Obamacare exchanges, which are much pricier.

The states must still receive approval from the federal government, which recently lost a second court battle over work requirements in Kentucky and Arkansas. The Trump administration is appealing that decision.

Advocates in all three states decried lawmakers’ moves, saying they are ignoring the will of the people. Tens of thousands fewer people will gain coverage because of the restrictions. Also, work requirements will cost the states millions to administer.

Recording the number of hours worked can be complicated, say opponents of work requirements. Some 18,000 people in Arkansas lost coverage last year, in part because they had a tough time with the online documentation system.

Opponents are also skeptical that work mandates will help Medicaid enrollees become more independent.

“There’s a reason why they aren’t working,” said state Rep. Ilana Rubel, an Idaho Democrat and House assistant minority leader. “Layering on more punishment is very unlikely to produce the desired results.”