Update 2-29-24. Sorry to report. SJR has passed both the House and the Senate and awaits the governor's signature. We will need to help SD voters see that we do not want to approve this on the November ballot!
Work Rule - Too Extreme and Inhumane for Medicaid Expansion
In 2022, the voters of South Dakota passed Medicaid expansion specifying no added conditions.
Now Senate Joint Resolution 501 wants SD voters to re-vote on Medicaid expansion in order to let SD take away Medicaid from those not reporting enough hours of work or work-like activity or verifiable disability.
--- The punishment (losing healthcare) is too extreme. Some legislators think a work requirement is ok for Medicaid, because SNAP has one. Those who get too few hours of work, or don’t get their report turned in, must find food somewhere, like a food pantry. But if the work rule goes on Medicaid too, they’d lose not only food but also their healthcare, and possibly their health. It’s an extreme and inhumane punishment.
--- Is it fair to put everyone through a ballot issue for a condition claiming to promote work when there is no evidence that it does? All evidence suggests it doesn’t.
Urge state representatives to Oppose SJR501.
Medicaid saves lives and health.
Save Medicaid for all who need it.
Why this change to Medicaid expansion should not be on the ballot:
In general, it is not wise to make policy based on the exception but which will then apply to the whole group. That is why work reporting for Medicaid expansion has so many problems, if the goal is to incentivize work.
The resolution should not be on the ballot, because (1) It is based on myths and stereotypes. It assumes that people covered by Medicaid expansion are not working. It assumes compelling people with the threat of taking away health coverage will get more people into the workforce. These are wrong. There is evidence to the contrary. Studies show most are working or doing some other activity that society needs (like family caregivers sparing the public a big nursing home expense) and that the requirement does not increase employment. Policies should be based on evidence.
It should not be on the ballot, because (2) there’s a chance it could pass. If it did, it would apply unnecessarily in two ways. (a) All the Medicaid expansion group would have the reporting burden. It would apply to the vast majority who are already working or in a situation that would likely be exempted. Low-income lives are generally complicated already. This added burden would not help them at all.
(b) Additional burdens would be on state workers to keep track of the majority who are working along with those who are not. Even more of a challenge would be determining the exemptions that would be needed and then tracking those who would be exempted or not. That would be a lot of additional tracking of our citizens’ activities by state employees.
It should not be on the ballot, because (3) if passed, some people would lose healthcare. A work requirement is against the purpose of Medicaid expansion, which was to get health coverage to low-income people who lacked it. Yet healthcare loss is what happens. This is an extreme and inhumane punishment for failure to report enough work or verify qualifications for an exemption. The punishment should fit the crime.
For example, the experience in Arkansas, before it was ruled as being against the purpose of Medicaid, was well studied. About ¼ of the people involved lost coverage, of whom 95% should not have been dropped. South Dakotans should not have to go through this nightmare. I hope the purpose of the initiative is not to cut the caseload.
“It cost the state an enormous amount of money. A bunch of people lost their healthcare,
and we have nothing to show for it.” -Arkansas Advocates for Children and Families
It should not be on the ballot, because (4) if passed, it would not incentivize work. If work is the purpose, this goal has been studied, and the results are in: There is no overall benefit to the workforce. Example: Like many reports on Arkansas’ experience, the journal Health Affairs Sept.2020, reported “work requirements did not increase employment over eighteen months of follow-up.”
It should not be on the ballot, because (5) it creates more shame and humiliation for low-income South Dakotans who need government programs. During most of this year, they would hear the false assumptions and stereotypes that they endure so often already. It may be hard for the rest of us to imagine how that feels.
People do not generally aspire to being on government help. I believe this is why Medicaid expansion enrollment has been so slow.
Also, they would have to live with this threat to their healthcare, because the initiative does not have specifics, so they would not know if they would still qualify for Medicaid. Before the election, they would not know what would happen to them in these situations, for which the state would need to develop policies:
Caretakers of all sorts
Part-time and seasonal workers
Workers between jobs
Domestic violence situations
Grandparents raising grandchildren
Gig workers and other Self-employed
Other jobs with unpredictable work hours
Various unstable health or housing situations
Conditions requiring ongoing medical care but able to work at times
Areas short of employment opportunities
The initiative does not recognize, but we must, that life and work for low-income people are precarious. As good neighbors, we surely want to be understanding and supportive, like the help we are offering with Medicaid expansion.
It should not be on the ballot, because (6) the Legislature had many years to accept Medicaid expansion and do so on its own terms. But not having done so, the Legislature should now respect the will of the voters.
Voters approved Medicaid expansion explicitly banning additional requirements. Did voters know that meant work requirements? Yes. Medicaid work requirement proposals and reports had been in the news throughout several years before November 2022. News media covered states submitting requests for “waivers” to allow them. News media reported on court cases. News media covered the experience in Arkansas.
For example, a Feb.18, 2020, KFF article notes that Medicaid work requirements were being covered in widely accessed media: The New York Times, the Associated Press, The Hill, NBC news, the Washington Post, Wall Street Journal, NPR, Bloomberg News, and CNN.
Update 2-16-24. SJR has passed the Senate, Next it will go to House State Affairs committee, as soon as Friday 2/23.
Please help stop it in the House.
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