The Medicaid Freeloader Fallacy

The lawmakers who want to take away my health insurance and I share two dreams: To get me working again, and to get me off of Medicaid.

Where we differ is in how those two goals fit together. For me, the objective is to get well enough that my neurological illness no longer keeps me stuck on my couch. I long to get back to my career as a lawyer, but I would prefer any job to my current isolation and frustration. I want nothing more than to interact with people daily, regain my financial independence and be a productive member of society.

If I can work, I almost certainly will make too much money to qualify for Medicaid. I would happily pay for my own health insurance if only I could earn an income.

I live in Colorado, one of at least a dozen states that are considering or in the process of imposing Medicaid work requirements, a policy mostly favored by conservatives. The Trump administration controversially announced in January that states could require Medicaid recipients to work with a federal waiver. Kentucky, Arkansas and Indiana already have federal permission to impose work requirements, and Alabama, Arizona, Kansas, Maine, New Hampshire, North Carolina, Utah and Wisconsin are requesting federal approval.

The Trump administration touts work requirements as good for recipients' health and a form of "compassion" that will help poor people "unlock their fullest potential," as Seema Verma, the administration's administrator of the Centers for Medicare & Medicaid Services, wrote in a column in the Washington Post.

Most policy experts argue the opposite, saying that Medicaid gives the poor access to health care that allows them to be healthy and work. Work requirements, paradoxically, will reduce access to health care and make it harder for people to work, health experts say.

Colorado Gov. John Hickenlooper, though a Democrat, is among those who would take away my Medicaid. Hickenlooper has positioned himself as a national health leader, fighting alongside Republican Ohio Gov. John Kasich to preserve insurance for Americans when the GOP Congress tried to dismantle the Affordable Care Act.

But Hickenlooper and others who support Medicaid work requirements either do not understand or do not care that taking away health insurance from those of us too sick to work seals our fate. Without access to medical care, we will lose our best chance at getting well and returning to work.

Proponents of work requirements claim people with disabilities will be exempt. But what they do not tell you, and may not even realize, is that people like me who are clearly disabled by any common-sense definition of the word are often not considered disabled by the government. That is because our government makes it deliberately difficult and time-consuming to qualify as disabled. The Washington Post recently reported that 10,000 people died in the past year while judges drown in the backlog of federal Social Security Disability cases.

The states run Medicaid, and Colorado and others rely on Social Security for disability determinations.

Work requirements solve a perception problem, not an actual problem. The majority of Medicaid recipients, both in Colorado and nationwide, already work. They are just so poorly paid that they still qualify for Medicaid. Most recipients who are not working are either sick or disabled like me; caring for a sick family member; or attending school, according to the Kaiser Family Foundation. Work requirements would address only what Hickenlooper called, according to the Denver Post, the "frustration ... that people are freeloading on the system."

Hearing my governor suggest that I am a freeloader only adds to the sting of being so debilitated. I got suddenly and extremely sick in September 2015. After months of disability leave and struggling to work part time, I eventually used up all the time off required under the Family and Medical Leave Act and lost my job in early 2016.

I am lucky enough to get a small monthly payment through private disability insurance. But despite convincing an insurance company of my disability, I have not yet convinced Social Security. I applied in the summer of 2016 after being sick for almost a year. Nearly two years later, I finally have a hearing scheduled for April for a judge to determine whether I am disabled.

Unless Social Security deems me disabled in April, I will be among the first to lose my health insurance if Colorado adopts Medicaid work requirements. That may doom me to a life of illness. But at least then I will not have to worry about being a "freeloader."