By Dennis Archambault
Michigan Senate Bill 897, which at this point is awaiting Gov. Snyder’s signature, will require able-bodied adults to maintain at least a part-time job in order to qualify for Healthy Michigan, the expanded Medicaid program. It actualizes a long-held desire by many legislators to force recipients to “have skin in the game,” or “earn” their social benefit. This is despite the assertion by several people working with safety net populations that most recipients of social programs work – some more than one job. And those who don’t work aren’t likely to work for a variety of reasons, most of which we would characterize as “social determinants of health.”
Recently, the Detroit Free Press published an interesting statistic: 53.4 percent of able-bodied Detroit residents don’t work. (https://www.freep.com/story/money/business/john-gallagher/2018/06/08/workforce-participation-detroit/674401002/) That’s largely due to lack of transportation, education, and skills. A large percentage of the population has re-entered society from a prison term. The Free Press didn’t provide a number that 53.4 percent represents, but in a city of 700,000 people, that represents a lot of people – a lot of people who will allow their health condition to worsen until they need emergency care. That, of course, means a lot of discomfort for people and a cost burden that some emergency health providers may not be able or willing to endure.
It’s unlikely that the unemployed will find work to maintain their health benefit. In a robust employment market like we have today, this population would be working.
The Michigan League for Public Policy has argued that “Having healthcare has helped people get and keep jobs, not the opposite… Aside from the complex bureaucratic red tape Medicaid enrollees will have to face and the increased administrative burden on our state caseworkers, this bill does absolutely nothing to address the barriers an individual faces in getting or keeping a job. In fact, it simply directs people to existing resources—resources in many ways that are significantly lacking. We have seen a recent uptick in conversations regarding transit, for example, with stories about trips in and around the Detroit Metro area taking two plus hours. And those stories don’t even account for bus delays, busses not showing up, or riders needing to get off a route to drop their kids at day care. Of course, many of the enrollees live in areas where transit just doesn’t exist.”
The legislators who remain in office long enough to monitor the effects of this legislation will eventually will face the unintended consequences of their action: increased demand on hospital emergency services for primary care and complications of diseases best managed in a medical home.
Dennis Archambault is vice president for Public Affairs at Authority Health.