Back in August, The Denver Post’s John Ingold scrutinized statements from conservatives that Colorado should free up money for transportation and education, among other state programs, by removing “able-bodied” adults from Medicaid, the state-federal health insurance program for elderly, disabled, and other poor people.
He concluded Colorado could save “hundreds of millions of dollars” if “non-disabled adults” were removed from Colorado’s Medicaid program ― not a huge savings in the state’s current general fund budget of close to $11 billion.
But are we talking $200 million or $800 million? And who are these (presumably) strapping folk that would lose their health insurance if some conservatives have their way?
I put the question to Henry Sobanet, the budget director for Colorado Governor John Hickenlooper, who briefed reporters on the Hickenlooper’s proposed budget last week.
He confirmed that there is no group of Colorado Medicaid recipients officially called “able-bodied.” The closest category we have in Colorado’s Medicaid program, he said, are the 192,000 “non-expansion parents,” earning about $32,000 per year for a family of four, who are projected to require $308 million from the general fund next year.
These aren’t the folks added to Colorado’s Medicaid program under Obamacare. As Ingold reported, Colorado isn’t laying out any money directly for them, as they’re covered by the federal government and an enterprise fund, so cutting those folks from Medicaid won’t save the state much of anything.
But just because “non-expansion parents” aren’t in the Medicaid category of “people with disabilities” doesn’t mean they are “able-bodied,” according to Medicaid experts. Many have chronic medical or psychological problems that make them much less than able-bodied.
Some are fully disabled, but have yet to be categorized as such, because they haven’t been diagnosed or even reported their problems.
And the trouble is, while people familiar with Medicaid will tell you a significant number of the 192,000 “non-expansion parents” aren’t really able-bodied, no one knows how many are disabled or partially so.
And Medicaid officials didn’t want to hazard a guess.
But Medicaid backers say it’s irrelevant how many “able-bodied” people are on the rolls anyway, because Medicaid exists to help struggling citizens who can’t afford health insurance. The program represents the commitment to help anyone who’s hit hard times, even if they are able-bodied, they say.
Natalie Wood, Senior Policy Analyst at the Bell Policy Center, a progressive organization, believes the phrase “able-bodied” is being used to demonize vulnerable citizens who need assistance.
“‘Able-bodied adult’ is the new ‘welfare queen’ – a mythical, undeserving American who is somehow not worth helping,” said Wood via email. “Talking about ‘able-bodied adults’ moves the conversation away from the goal of covering every Coloradan. The sooner we reach consensus on this, the sooner we can focus on how to make the system work for everyone without jeopardizing the health and lives of some of the country’s most vulnerable people.”
In fact, many of the “non-expansion parents,” who do not face chronic medical conditions and thus may be considered “able-bodied,” have simply fallen on hard times, due to the Great Recession, structural weaknesses in the American economy, or other problems, and are struggling to get back on their feet ― or find their feet for the first time, Medicaid proponents say.
About 75 percent of this group of Medicaid recipients is already working, according to the Colorado Department of Health Care Policy and Finance. Their employers often don’t offer health insurance and sufficient wages or hours to allow them to meet their basic needs in Colorado, where about a quarter of workers earn less than $12.48 per hour, according to the left-leaning Fiscal Policy Institute.
So it’s likely that dropping these low-wage workers from Medicaid would shift costs to hospitals, in the form of uncompensated care, due to the fact that hospitals are required by law to accept emergency patients, with or without insurance.
More economic opportunities can put low-income people back on their feet and off Medicaid. In fact, this year’s budget projects more than 18,000 fewer Medicaid recipients than anticipated, according go Sobanet, the governor’s budget director.
“Some people qualify for Medicaid based on their income,” said Sobanet, when asked about less-than-expected Medicaid caseload. “The unemployment rate is low. And if someone finds a job and there’s health insurance, or they disqualify by earning, they fall off of Medicaid.”
The growth of the state Medicaid budget has slowed, but it’s still increasing. Next year’s projected 3.5 percent growth rate in the program is half of recent average increases. But at a $98.2 million increase, it’s highest dollar jump among major state budget categories.
If conservatives succeed in their effort to reduce the complex reasons that adults need Medicaid down to whether adults are “able-bodied,” then the CDHCPF may be required someday to provide better information on the number of Medicaid recipients who fall into the category, however it’s defined.
Asked why his government agency has little information about and no definition of “able-bodied” Medicaid recipients, Marc Williams, Public Information Officer for the Colorado Department of Health Care Policy and Financing, stated in an email, “We are required to implement current state and federal law, and under current law, Medicaid eligibility is based on citizenship and income requirements. Should federal and state law change to require additional eligibility criteria, those requirements would be added to the eligibility determination process and we would follow that law.”
Michael Fields, senior director of Issue Education for Americans for Prosperity, would probably like to see this happen.
“As I tweeted a few months ago, everyone wants children and people with disabilities to be covered, but the discussion has to be about the other half of people on Medicaid,” said Fields via email, adding that “not every able-bodied adult is in the same situation – and therefore shouldn’t be treated the same.”
Fields is concerned about the long-term impact of Colorado’s Medicaid program on the wider state budget. He points to escalating costs, saying the situation is worse after 35,000 new Medicaid subscribers, called “welcome mat” enrollees, discovered during the Obamacare roll out that they were eligible for Colorado’s Medicaid program and signed up. And, indeed, the state’s Medicaid budget has increased, from 17 percent of the general fund in 2000 to 26 percent this year ― though the 42 percent of the Medicaid spending comes from taking care of people with disabilities and in nursing homes, and they make up only 10 percent of Medicaid enrollment.
Still, Fields has valid concerns, which need to be addressed given the state of Colorado’s budget. Partisans on both sides agree with that.
But Republicans aren’t helping matters when they say Medicaid’s budget problems, much less Colorado’s, can be solved by taking health insurance from “able-bodied” adults.