Editor’s note: Mia Ives-Rublee is the director for the Disability Justice Initiative at the Center for American Progress and has advocated for disability justice and inclusion at nonprofit organizations and businesses across the United States. The views expressed here are her own. Read more opinion at CNN.
House Speaker Kevin McCarthy and nearly all House Republicans voted late last month to rip away health coverage from hundreds of thousands of people like me, passing a measure that would impose work requirements as a condition of eligibility for Medicaid as part of their bill to raise the debt ceiling. If McCarthy’s bill becomes law, an estimated 600,000 people would lose coverage.
People who depend on the program for basic checkups, complicated medical procedures and community living could be harmed. As politicians quibble over rules, they ignore the real impact those funding cuts would entail. I know this first hand because two decades ago, I was a Medicaid recipient.
I was born with a congenital disability called Osteogenesis Imperfecta, which makes my bones brittle. After graduating from high school, my parents immediately helped me sign up for Supplemental Security Income, which made me automatically eligible for Medicaid.
I spent four years as an undergraduate with the assurance that, if I were to get sick or injured, I wouldn’t go into severe debt. The fact that there were no work requirements attached to my health coverage gave me the freedom to pursue an education.
During the first week of graduate school, I fell and broke my femur. I was covered when I was rushed to the emergency room and doctors needed to perform surgery due to the severity of the break.
Unfortunately, during surgery, the surgeon accidentally broke my femur into several more pieces. This landed me in the hospital for almost two extra weeks, and I had to receive an emergency transfusion and second surgery.
As a result of the surgeon’s poor job on the second surgery, I underwent eight or nine more surgeries over 10 years in an attempt to fix a nonunion fracture. Medicaid covered hundreds of thousands of dollars in surgeries, hospitalizations, therapy and pain management. Without Medicaid, there is no way I could have covered the significant cost, which would have made it difficult for me to stay in graduate school and obtain and maintain a job later on.
In so many ways, being eligible for Medicaid two decades ago laid the foundation for the life I have now. Thanks to Medicaid I was able to get care when I needed it and stay out of medical debt through all my surgeries. And because my eligibility wasn’t tied to a job, Medicaid allowed me to pursue my education full time, leading to a career giving back as a social worker, advocate and researcher at a top think tank.
I am not alone. First enacted in 1965, at the same time as Medicare, Medicaid today provides coverage for low-income individuals, blind people and those with other total and permanent disabilities.
Over 86 million people, more than 25% of the population, are enrolled, making it one of the biggest federal safety net programs in the United States. Of these, about 20 million people are currently covered though the Affordable Care Act’s Medicaid expansion.
Contrary to what McCarthy and his allies would have you believe, a majority of individuals on Medicaid either have a significant disability or are currently working.
According to a Kaiser Family Foundation analysis of 2021 federal survey data, 61% of non-elderly Medicaid recipients already work, 13% were not working due to caregiving, 11% were not working due to an illness or disability, and 6%, like me, were not working due to school.
That leaves just a small sliver of the population that the work requirements would actually be targeting. Studies of Arkansas work requirements show that it led to thousands of recipients losing their eligibility status, including those who had jobs, and saw negligible impact on getting people to work or stay working.
In addition, many individuals who were already working stated that the reporting requirements created significantly more stress. In short, work requirements don’t actually work as anything other than a Republican talking point.
They are also extremely complicated and expensive to administer. The Government Accountability Office had five states report the estimated implementation costs for work requirements, which ranged between $10 million to over $270 million.
Kentucky estimated it would cost over $270 million with the federal government bearing 87% of the cost. Other state administrators who implemented work requirements on programs like SNAP reported it being an “operational nightmare,” resulting in eligible recipients being terminated from the program.
Medicaid’s stated mission within the Social Security Act is to provide “medical assistance on behalf of families with dependent children and of aged, blind, or disabled individuals, whose income and resources are insufficient to meet the costs of necessary medical services.”
The program helps stabilize millions of individuals and families, allowing them to care and stabilize themselves. Work requirements actually counter their own mission by making some of the most needy ineligible.
Some argue that the bill has little chance of becoming law with a Democratic president and Democrats running the US Senate. That doesn’t reassure millions who depend on the program for basic checkups, complicated medical procedures and community living.
There is always a chance during negotiations that a watered-down version of the GOP bill impacting Medicaid could be at play if those who support Medicaid don’t push back.
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It’s essential that we prioritize the health of all communities, particularly those with fewer resources. We can do this by not adding ineffectual administrative requirements to a program that was intended to help all individuals who are unable to access necessary medical services due to low or lack of income and resources.
Without Medicaid to help address my medical issues early on, I may not have had the opportunity to have the career I have today due to being under the stress of chronic physical pain and thousands of dollars in medical debt.
Politicians need to understand that the statistics and numbers they throw around are actual people who rely on Medicaid, people like me.