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Republicans who run the Statehouse are considering bills that would create a work requirement for recipients of Medicaid health coverage.
Sure, it sounds good. Gov. Kim Reynolds and lawmakers argue requiring work will lift Iowans out of dependence on state services and into the workforce. She wants "able-bodied" Medicaid clients between the ages of 19 and 64 to work 80 hours each month.
There would be exemptions for Iowans who deemed medically frail or medically exempt under Medicaid; are a caregiver of a child younger than age 6; have a high-risk pregnancy; are receiving unemployment, participating in substance use disorder treatment, or are exempt for "good cause" by the Iowa HHS director.
Iowa must receive a federal waiver to put work requirements in place.
KFF, an independent source of health care data, reports 75% of Medicaid recipients in Iowa work. The governor claims 100,000 able-bodied people covered by Medicaid are not working. Her calculation counts recipients who are working but earn $551 or less each month. Earning That doesn't seem the same as "not working."
This one-size-fits-all solution will leave some Iowans who qualify for Medicaid without coverage if they fail to jump through new bureaucratic hoops created by the bill.
That's what has happened in other states.
Arkansas adopted Medicaid work requirements during President Donald Trump's first term. During the nine months they were enforced, 18,000 Arkansans lost Medicaid coverage. KFF found the main reason was eligible recipients became tangled up in a confusing work reporting process, or they had no idea the policy was in place.
And Arkansas saw no increase in employment or work hours under the work requirement.
There are many stories that show the approach is more damaging than beneficial. In Arkansas, researchers found a man who was working despite a chronic health condition. He lost Medicaid coverage, the condition worsened, and he had to quit his job.
Chaney Yeast with Blank Children's Hospital in Des Moines told a legislative subcommittee many Iowans covered by Medicaid are "working poor."
"They're working, typically, multiple part-time jobs," Yeast said, according to The Gazette's Tom Barton. " ... So we're talking about the 20-year-old waitress at the local café that has diabetes and she relies on Medicaid for her insulin and her blood glucose pump. We're talking about the 19-year-old that stocks the grocery store shelves ... who has Crohn's disease and relies on Medicaid to pay for their Remicade infusions every six weeks.
"We're talking about the 21-year-old student that maybe is trying to get her certified nursing assistant degree and she's going to school," Yeast said.
We know that federal changes to Medicaid, including funding cuts, are also being discussed which could have an even bigger impact.
There must be ways to make Medicaid more efficient without leaving sick Iowans behind. Health care coverage is a fundamental need. Maybe the state could address why so many Iowans can't afford their own health coverage. That's the issue, not politically driven measures that will punish poor Iowans.