Lori Kelley’s diminished visual acuity has presented considerable obstacles in securing stable employment.
The 59-year-old resident of Harrisburg, North Carolina, ceased operations of her non-profit circus arts academy the previous year due to an inability to perceive sufficiently for administrative tasks. Subsequently, she undertook employment at a pizzeria, involved in dough preparation for a period. Presently, her occupation involves the segregation of recyclable materials, such as beverage containers, at a local entertainment venue. This position constitutes her principal financial resource, however, the work is not consistently available throughout the year.
“This establishment is familiar with me, and I am valued here,” Kelley remarked regarding her employer. “I am not compelled to justify to them my inability to read.”
Kelley, who resides in a recreational vehicle, subsists on an annual income below $10,000. She attributes her capacity to manage on this amount, in part, to her Medicaid health insurance, which defrays the cost of her arthritis and anxiety medications and has facilitated medical consultations to monitor her hypertension.
However, she expresses apprehension regarding the potential loss of this coverage in the forthcoming year, when new regulations mandate that millions of individuals, including Kelley, engage in work, volunteer activities, educational pursuits, or other qualifying endeavors for a minimum of 80 hours per month.
“I am currently experiencing fear,” she stated.
Prior to the legislative enactment of these coverage modifications, Republican legislators posited that young, unemployed men were exploiting the governmental health insurance program, which furnishes coverage to numerous individuals with limited financial means or disabilities. House Speaker Mike Johnson informed CNN that Medicaid is not designed for “29-year-old males lounging on their sofas playing video games.”
Conversely, according to Jennifer Tolbert, deputy director of the Program on Medicaid and the Uninsured at KFF, a health information non-profit entity that includes KFF Health News, adults aged 50 to 64, particularly women, are anticipated to be disproportionately affected by the new stipulations. Tolbert indicated that for Kelley and others, the employment mandates will erect impediments to retaining their coverage. A significant number might consequently forfeit Medicaid, thereby imperiling their physical and financial well-being.
Commencing in January of the subsequent year, approximately 20 million low-income Americans across 42 states and Washington, D.C., will be required to satisfy activity stipulations to either obtain or maintain their Medicaid health coverage.
Alabama, Florida, Kansas, Mississippi, South Carolina, Tennessee, Texas, and Wyoming did not extend their Medicaid programs to encompass additional low-income adults under the provisions of the Affordable Care Act; consequently, they will be exempt from implementing these employment regulations.
The non-partisan Congressional Budget Office forecasts that these employment mandates will lead to a reduction of at least 5 million individuals with Medicaid coverage over the ensuing decade. Critics contend that these work requirements represent the primary catalyst for coverage attrition stemming from the GOP budget legislation, which curtails federal spending by nearly $1 trillion to offset the fiscal impact of tax reductions primarily benefiting affluent individuals and to enhance border security.
“We are discussing fiscal prudence at the cost of human lives,” asserted Jane Tavares, a gerontology researcher affiliated with the University of Massachusetts Boston. “The prerequisite for employment functions merely as an instrument to achieve this objective.”
Andrew Nixon, a spokesperson for the Department of Health and Human Services, stated that mandating that “able-bodied adults” engage in employment is intended to ensure Medicaid’s “long-term viability” while concurrently preserving it for those in need. Nixon informed KFF Health News that exemptions are provided for individuals with disabilities, caregivers, expectant and postpartum mothers, veterans with total disabilities, and others experiencing medical or personal hardship.
According to researchers at Georgetown University, Medicaid expansion has served as a critical support system for middle-aged adults who would otherwise lack health insurance. Approximately one in five Americans between the ages of 50 and 64 are covered by Medicaid, granting them access to healthcare services before they become eligible for Medicare at age 65.
Tolbert noted that among women enrolled in Medicaid, those aged 50 to 64 are more susceptible to encountering difficulties in maintaining their coverage compared to their younger female counterparts and are likely to have a more pronounced need for healthcare services.
These middle-aged women are less likely to be fulfilling the requisite hours of work, as a considerable number serve as familial caregivers or suffer from health conditions that impede their capacity to engage in employment, Tolbert observed.
Tavares and fellow researchers determined that a mere 8% of the overall Medicaid beneficiary population is classified as “able-bodied” and not currently employed. This demographic is predominantly comprised of women experiencing extreme poverty who have withdrawn from the labor force to assume caretaking responsibilities. Within this specific group, one in four individuals are aged 50 or older.
“They are not healthy young adults idly spending their time,” the researchers concluded.
Furthermore, Tolbert suggested that making it more arduous for individuals to sustain Medicaid coverage “may actually impede their ability to work” due to the untreated nature of their health ailments. Irrespective of coverage status, she added, the chronic health conditions of this demographic will necessitate ongoing management.
Adults frequently begin to contend with health challenges prior to attaining eligibility for Medicare.
Health policy analysts suggest that if older adults lack the financial resources to address health issues before reaching the age of 65, they will present with more severe health conditions upon qualifying for Medicare, thereby increasing the financial burden on the program.
Numerous adults in their 50s and early 60s have ceased working due to their full-time roles as caregivers for either children or elderly family members, according to advocates for caregivers, who refer to individuals in this category as “the sandwich generation.”
Nicole Jorwic, chief program officer for the organization Caring Across Generations, stated that while the GOP budget legislation does permit certain caregivers to be exempted from Medicaid employment mandates, these exclusions are “exceedingly limited.”
She expressed concern that individuals who genuinely qualify for an exemption may be overlooked.
“You will witness family caregivers deteriorating, continuing to neglect their own healthcare needs, and subsequently, you will observe an escalation in families facing crisis situations,” Jorwic predicted.
Paula Wallace, a 63-year-old resident of Chidester, Arkansas, recounted her decades of professional employment, followed by her current role assisting her husband in managing his advanced cirrhosis.
After a prolonged period of being uninsured, she recently acquired coverage through her state’s Medicaid expansion program, necessitating her compliance with the new employment requirements to retain it. However, she is finding it exceedingly difficult to envision how this will be feasible.
“Given that I am his sole caregiver, I cannot venture out to work away from our residence,” she explained.
Wallace’s husband receives Social Security Disability Insurance, she stated, and the law stipulates that she should be exempt from the employment mandates as a full-time caregiver for a disabled individual.
However, federal authorities have not yet disseminated specific directives clarifying the definition of this exemption. Moreover, the experiences of Arkansas and Georgia – the only states to have previously administered Medicaid work programs – demonstrate that a substantial number of enrollees encounter difficulties navigating complex benefit systems.
“I am profoundly apprehensive,” Wallace conveyed.
