Arizona in the final stages of drafting a proposal for the state’s Medicaid plan, and major pieces include adding a work requirement for “able-bodied” adults and a five-year lifetime limit — conditions that may sound appealing but don’t jibe with reality and have the real potential to harm people who need help most.
Some point to the 1.9 million Arizonans (300,000 in Pima County) who depend on Arizona’s Medicaid program for medical care and say the problem is too many people are dependent on the government.
We see it differently: One in four Arizonans makes so little pay they can’t afford to see a doctor. That’s a much thornier problem.
Our state Medicaid program is the Arizona Health Care Cost Containment System, or AHCCCS. Eligibility is capped at 138 percent of the federal poverty level, which in 2017 is $16,643 for an individual and $33,948 for a family of four.
State officials, including those in the Governor’s Office, must resist the pull-yourself-up-by-the-bootstraps mythology or a viewpoint that sees poverty a personal failing.
We are not eschewing personal responsibility, but rather looking at the needs of Arizonans in a more systemic way. Medicaid enrollment is one way to evaluate the economic and community health of a state. Many of the 1.9 million Arizonans on AHCCCS hold jobs. They are the working poor whose employers don’t offer benefits, or if they do, the premiums are unaffordable.
It’s not yet clear how many people now on AHCCCS would be affected by a work requirement. Simply finding a job isn’t the road out of poverty.
Finding a job — and keeping it — is dependent on far more than a person’s willingness to work. Childcare and reliable transportation are necessities.
According to reporting by the Star’s Stephanie Innes, an early draft released last year stated that attending school or being in a job-training program at least 20 hours a week would qualify.
Other potential conditions raise red-tape flags, however. For example, enrollees would have to verify their work status and any changes in family income monthly. Any failure to do that and AHCCCS could suspend the recipient for one year. Health care is too vital a human need to be subject to the vagaries of bureaucracy and paperwork.
Proponents of the limits say that the existing system entices able-bodied people on AHCCCS to not get a job, so they don’t lose their medical benefits. This is sometimes true, and it’s a perverse side-effect of a system where health-insurance costs are unaffordable. Arizonans shouldn’t need to choose between working and medical care.
A full-time minimum-wage job in Arizona puts you over the income limit for AHCCCS, but, if your employer doesn’t offer insurance benefits, it isn’t nearly enough to buy private health insurance — especially if Republicans in Congress are able, in the future, to dismantle existing subsidies available through the Affordable Care Act.
The five-year lifetime limit for AHCCCS enrollment is another proposed change that could end up harming vulnerable Arizonans. Poverty is often entrenched, generational and doesn’t have an expiration date.
A spokesman for Gov. Doug Ducey said that officials are combing through hundreds public comments before they complete their plan. The federal government has the final say on the changes.
We await the final version and ask state officials to keep Arizona’s financial realities in mind.