A Word on Work Requirements

Arkansas began a "soft launch" of Medicaid work requirements on July 1. Nobody loses coverage yet. In January, the penalties start.

Start with the part nobody's saying out loud. The federal deadline to have this in place is January 1. Arkansas didn't wait for it. We moved on July 1, alongside Montana, among the first states in the country to act. We went early, by nearly six months, on the one policy Arkansas has already tried and already watched fail.

Here's the receipt. Arkansas was the first state in the nation to try this, back in 2018. It cost $26 million to administer. In return, 18,164 Arkansans lost their coverage. Employment did not go up. Not a little. Not at all. The New England Journal of Medicine studied it and found "no significant changes in employment associated with the policy, and more than 95% of persons who were targeted by the policy already met the requirement or should have been exempt." The Urban Institute went back last year and ran the numbers again against Census data. Same answer. Twenty-six million dollars, and no measurable gain in employment.

The governor has been clear about who she believes this is for. Announcing the rollout, she said Arkansans "shouldn't have to subsidize healthy adults who choose to stay on the sidelines."

Set that next to the research. More than 95% were already working, in school, caring for somebody, or too sick to hold a job. The sidelines were mostly empty. What the policy actually found wasn't people refusing to work. It was people who couldn't get through the paperwork.

Perhaps that was the point.

Which brings us to the fine print from the first go-round, and this is the part worth revisiting. Arkansas made people report their hours online, and only online, for the first six months. Why? Because the state drew a better federal match rate on technology than it did on people answering phones. The reporting system got built around what Washington would reimburse, not around whether Arkansans could actually use it. And let's not forget we ranked near the bottom of the country in broadband at the time. Among people subject to the requirement who came up short in a given month, almost 99% reported nothing at all. Zero hours. That's not what refusing to work looks like. That's what never getting the message looks like.

The real cost never stopped at $26 million, either. Insurers were told to fold their administrative costs into their premiums, which raised rates on Arkansans buying their own coverage on healthcare.gov who had nothing to do with any of this.

This time the state expects as many as 42,000 people to lose coverage. Arkansas already leads the nation in the share of rural hospitals vulnerable to closure. Labor and delivery keeps disappearing from small towns. One of the two insurers on our expansion has already announced it's walking away in January. Everybody who loses coverage still gets sick. They just show up at the emergency room with no way to pay, and the hospital eats it. So much for not subsidizing our neighbors.

"Welfare to work" plays well in a Republican primary. But in reality, it's nothing but empty, cynical words when there's no real support for Arkansans to get from welfare to work. Just a slogan slapped over the real game plan, which is to take away support from Arkansans who need it.

The governor and her allies in Little Rock know that already. After all, we've done this before.

KMI