Gail Wilensky Discusses the Impact of Waivers on State Medicaid Programs

Although Gail Wilensky PhD, senior fellow at Project HOPE, is doubtful that imposing work requirements in Medicaid will have much effect, either positive or negative on enrollment, but she thinks it will help bring to the table states that were not otherwise willing to expand Medicaid.

Transcript

What impact do you think the Trump administration’s willingness to provide waivers to states for their Medicaid programs could have on healthcare outcomes?

I think there is a philosophical issue that many Republicans, including the Trump administration, have taken, which is that states ought to be allowed to make some adjustments in programs so that it best suits the needs of their state citizenry as the elected officials see it. In this case, it may be ironic that it is the ability to impose work requirements that may be what draws some of the states that have been reluctant to expand their Medicaid program into an expansion.

I’m somebody who has taken the position that I’m doubtful that the work requirement will have nearly as much effect positive or negative as either it’s supporters or detractors claim. But I think if it brings people to the table who have not otherwise been willing to expand Medicaid, we ought to realize this a great step forward. The problem that people who are supporting the expansion don’t fully appreciate is that only some of the populations on Medicaid are able to work and many of those who are able to work are actively either working or seeking work. Allowing them to have alternatives, community service, training, in addition to actually being employed means that it will allow people who are looking but are unable to find work at the present time not to lose their Medicaid coverage which is very important. I think there may be a surprise that the population is not bigger than it is, but if it’s enough to allow a state that has been reluctant to expand to embrace the Medicaid expansion, it is well worth the effort.

If you actually cut people off from Medicaid because they don’t comply, it is an area that you ought to have mixed feelings about. It’s one thing to take away some financial support either through food stamps or welfare payments to take away needed medical care is a more draconian measure and if people are sick enough or become sick enough they can always show up in the very expensive emergency room which is hardly a game for anybody, the state or the individuals. So, I hope it is an effective club but not one that will actually be taken and used in terms of taking away Medicaid coverage.