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The right wing is overly exultant about the new work requirement for Medicaid expansion recipients. The left wing is overly aghast.

It might be that these are permanent states of mind on these wings.

It could be that a work requirement before drawing Medicaid expansion money for health insurance is only the latest issue suitable for plugging into that standing construction of our generally overwrought political condition.

Some on the right think poverty is one's own fault. They contend it's not our responsibility through government to take care of a bum as he sinks deeper into a lumpy couch and watches daytime television while his fingers turn orange from Cheetos.

They think a work requirement will get freeloaders off the couch.

But most Medicaid recipients work already, or try to, if irregularly. What they tend to land is a no-benefit, hard-labor and temporary job that pays dirt and goes away seasonally or without warning.

Some on the left think a work requirement is a death sentence for the poor and sick at the hands of mean people who don't even try to understand being poor--and who insult poor people with their stubborn misapprehensions.

Here's one thing you can do amid such division: You can look at the program, which is scheduled to begin its first phase of operation June 1.

The work requirement will apply in that first phase only to those able-bodied between the ages of 30 and 49. The second phase next year will add those able-bodied from ages 19 to 30.

All those younger and older are exempt. Anyone in those groups responsible for caring at home for dependent children will be exempt. Those who are chronically ill or pregnant will be exempt.

What it comes down to is that, of the 285,000 persons now covered by Medicaid expansion in Arkansas, about 30,000 will be affected in the first phase and 30,000 in the second.

Here's what they must do: Go online and choose work or job training or volunteer service and come back online next month, and the month after, to attest that they've spent 80 hours engaged in the activity to which they've committed.

The state will do spot checking. It also will do targeted checking of anything that looks dubious.

If one fails to attest for three months, he loses health insurance for a time, after which he can seek to get it back.

The mainstream conservative view is that poor people will come out of this with newfound opportunities for life-transforming work--through new information about free job-training or job-search programs.

The mainstream progressive view is that it's unfair to hassle poor people generally and to un-insure anybody anytime, especially punitively and especially over online paperwork.

I told a well-connected Republican state legislator that it seemed to me that there was one horrible risk of the work requirement--that the poor soul likeliest to lose health insurance is one without a computer or computer skills who fails to make the necessary mouse click for three months running.

Oh, no, the legislator argued. Remember that these policies are with private carriers like Blue Cross. Those firms will not want to lose thousands of reliable on-time premium collections, the legislator said. They'll do the vital outreach to keep those folks covered, or at least responsive to the prescribed process, he predicted.

One hopes.

One person who got some of this right--this time--was state Sen. Terry Rice of Waldron.

He's a conservative Republican state legislator who had previously voted consistently against Medicaid expansion. But he stepped up this time to cast the vital 27th "yes" vote for the appropriation in the Senate on Tuesday.

He said it was not the work requirement that brought him around. He said that was fine as far as it went, but that it was surely less than the salvation of a program that he said--rightly--is not sustainable at the current cost-rising pace.

But he said he was weary of a pattern of crisis and brinkmanship starting in 2013 over whether to continue the program. If the appropriation had failed, he said, the governor would have called the Legislature into special session in another 60 to 90 days for another exercise in crisis and brinkmanship, though the facts wouldn't be any different.

He chose to step back and punt to the regular session of 2019, when maybe we'll know more about the work requirement and other ideas to cut costs.

His was a sensible vote. It provided the latest means by which Medicaid expansion clung implausibly to life in a state in dire need of it but without a great appetite for it.


John Brummett, whose column appears regularly in the Arkansas Democrat-Gazette, is a member of the Arkansas Writers' Hall of Fame. Email him at Read his @johnbrummett Twitter feed.

Editorial on 03/08/2018

Print Headline: Expansion hangs on

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