By Amy Hathaway - appeared in the Concord Monitor on April 26, 2018
Thanks to Medicaid Expansion, more than 52,000 Granite State residents are able to access health care through the New Hampshire Health Protection Program.
Since the program began in 2015, 130,000 people have received access to life-saving, preventative health care, addiction treatment, and routine outpatient care that many of us with private insurance take for granted.
Medicaid expansion has provided insurance to people when they have lost their job, has given people access to health care who work for low wages at companies that don’t offer insurance, provided an opportunity for people addicted to opioids to get into recovery programs, and has made our hospitals and community health centers more sustainable.
A bill is currently in the legislature to re-authorize New Hampshire’s program for another five years, but it would introduce new work requirements that could shut out many of the people Medicaid expansion is supposed to help – and burden many who get their health care through Medicaid now.
The state of New Hampshire is asking the Trump administration to allow it to impose requirements that Medicaid-eligible individuals work an average of 25 hours per week, making it the most punitive work requirement in the country. If paid work cannot be found, people could be forced to perform unpaid labor in order to fulfill the mandatory work requirements. In some cases, self employment, providing care to an ill or disabled family member, education and job training, or participation in a substance abuse recovery program could meet the requirement.
These forced labor requirements will mean people will have to juggle more, not less, in order to get the health care they need. The new rules punish people who face discrimination based on race, gender, or disability. They will take a toll on communities where jobs are scarce and will hurt people struggling with substance use and mental health issues. These forced requirements could destroy the promise of health care at a time when people need that promise the most.
Proponents of the work requirements will tell you that this is a way to get more people into the New Hampshire workforce. But, most working-age adults without a disability who use Medicaid already work, and many of them have jobs thanks to Medicaid — not despite it. That’s because Medicaid helps them get and stay healthy enough to work.
Currently 65 percent of people who are on the NH Health Protection Plan are employed. The remaining 35 percent are mostly people who are physically unable to work, have young children at home, or are caring for a family member. Our short history with the program indicates that most of these people will return to work as soon as they are able. Managing a work requirement program will be challenging, time consuming and expensive, and will create a new layer of bureaucracy to vet and review compliance with the new requirements. And, with few job opportunities in parts of New Hampshire, this means many will be forced into unpaid labor, and in many cases with no reliable transportation to help them keep their health care. These extra barriers could make is so that some Medicaid-eligible people will be denied access to health care or never even apply and become so ill that it will take even longer for them to return to work.
This is part of a disturbing trend with the Trump administration, which announced an executive order on April 10th that it will force people into unpaid labor or part-time work in order to receive any public benefit—including housing, food, and health care. That kind of servitude in exchange for basic needs has no place in New Hampshire or our country.
Certainly the state has a role to play in helping people get training and work experience in order to find better jobs and build our states economy, but keeping people from seeing a doctor is not the way to build a healthy workforce.
Amy Hathaway, OTR/L, of Keene, is an Occupational Therapist and Educator, and is the co-founder of the Monadnock Progressive Alliance.