Medicaid work requirements: Proposal sounds appealing, but is far from it

Every once in awhile, a proposed piece of legislation threatens to be so harmful that it warrants special attention. The bill in question essentially compels "able-bodied" people to work or lose the health care they receive through Minnesota public programs. On its face, it sounds appealing. However, not only would this proposal increase taxes and cause counties to hire more employees, it would actually make the poverty situation worse.

In addition, it does not allow counties, which would have to bear the financial burden, any voice in the decision. After all, if it were so good, the counties, which represent both parties, would leap to support it.

How odd it is that Republicans who rail against taxes, government bureaucrats and unfunded costs imposed by state government find this bill so attractive. The magnet is the campaign money available to them via the Koch brothers of Kansas and their allies on the political extreme. It is expected that they will spend well over $400 million in the 2018 elections alone.

More than 125 Minnesota groups stand firmly opposed, including counties, doctors, nurses, mental health providers, disability advocates, addiction specialists, hospitals, nonprofits and other health care organizations. State fiscal experts say it would cost the taxpayer millions of dollars with no savings to the state budget.

For our local governments, the cost of this bill would be real and would require cuts to existing local programs or higher property taxes.

This bill did not originate in the minds and hearts of Minnesota lawmakers. Instead, it came from national anti-government groups, like Americans for Prosperity, the only group to testify in support of the bill in the Senate, which has deep ties to major campaign donors with extreme political and corporate agendas like the billionaire Koch brothers from Kansas.

Further, they tell us that we need to follow the lead of states like Kansas — and that work requirements in Medicaid will make fiscal sense for our budget, create reliable jobs with adequate wages and health insurance for all "able-bodied" Minnesotans, and solve the cycle of poverty. Nonsense, that is like telling the Vikings that they should aspire to be more like the hapless Cleveland Browns.

Consider this:

• Our state budget is healthy and our economy is one of the fastest-growing in the country. Kansas has a history of financial mismanagement and annual budget deficits plus a negative bond rating. It also has higher rates of poverty and unemployment. Minnesota also consistently ranks among the top six healthiest states while Kansas ranks in the bottom half of the country.

• This bill would not save money. State fiscal experts show it would cost Minnesota about $7 million annually by fiscal year 2021. This does not include the cost to the state over expected lawsuits and the added burden on local units of government. One metro county alone estimates needing nearly 250 new staff members to be funded by the local taxpayers at an estimated cost of more than $30 million.

• The bill would also leave people with no other choice but to once again flood emergency rooms or avoid seeing a doctor altogether. The risks have serious consequences on society and added costs to our hospitals and criminal justice system. More people with mental illness or addiction would have no choice but to go undiagnosed and untreated as long as possible because they lack access to affordable care.

Another truth is that reducing Minnesota's unemployment rate is not magically tied to a limit on Medicaid.

• Minnesota has an unemployment rate of 3.2 percent, which is lower than the national average. Unemployment, though, varies greatly by county and region. Hennepin County actually has the lowest rate of unemployment at 2.9 percent, while north and northwest Minnesota face much higher rates. Clearwater County, for example, has an alarming unemployment rate of 12.5 percent, with Marshall County following at 9.8 percent. Unemployment also varies by age, race and gender in Minnesota, all of which exist in a world with or without Medicaid.

• We also know that a person's health can impact their ability to find and keep a reliable job. This is especially true for U.S. veterans. About 13,000 veterans who live in our state are unemployed. Getting a reliable well-paying job is not always easy. This is especially true for those with serious mental illness, brain injuries, hearing problems and substance use disorders. Moreover, 8 percent of homeless adults in Minnesota are actually veterans and fewer than half have access to veteran benefits, thereby leaving Medicaid as the only option for receiving reliable health care.

• Getting Minnesotans out of poverty is not always as simple as imposing a work requirement on people already struggling to make ends meet. If this were true, the thousands of people on Medicaid who work would be climbing up the income ladder and out of poverty today. According to the Kaiser study of state Medicaid data among Medicaid adults and parents who would be included as able-bodied under this bill, about 8 in 10 already live in working families and the majority are working themselves.

Instead of partisanship, legislators should begin to reach across the aisle and invest the $7 million they plan to use for this bill into expanding programs we think succeed in improving job opportunities — like Minnesota Goodwill Easter Seals, which works with people in poverty to find jobs. Legislators could also incentivize doctors to connect their patients on Medicaid to employment supports. A notable program that has been doing this type of work is Twin Cities RISE!.

Everyone should be able to access programs like these, especially those living in areas where unemployment rates are high, such as the northern rural regions of the state. Legislators could also establish a committee to monitor the progress and recommend ways to improve employment opportunities for future generations. Minnesotans deserve quality public policy.

What is needed is a genuine bipartisan effort to understand and develop policy along with local governments that will actually help people succeed.

Arne Carlson, a Republican, was governor of Minnesota, 1991-1999. Linda Berglin, DFL-Minneapolis, was a member of the Minnesota Senate, 1981-2011.