The push to require Medicaid recipients to get jobs has at least some support from everyone running to be Tennessee governor — even the Democrats.
At a recent forum, House Speaker Beth Harwell took the hardest line. She's already proposed legislation that would make the state's Medicaid program — TennCare — require able-bodied beneficiaries to show they're working, taking care of family or at least volunteering. The legislation has yet to be debated in the General Assembly after the Trump administration allowed this flexibility.
"We need to provide for those low-income people a safety net while they go through some difficult time," Harwell said. "But it does not need to be — or turn into — a lifetime entitlement program."
Though she didn't attend the forum, Congressman Diane Black has said she would "immediately" request a waiver to allow Tennessee to impose work requirements.
"It’s not just about protecting taxpayer dollars from fraud and abuse; it’s about creating a culture of work and the dignity that comes from that work," she said in a written statement January 11.
Businessman Bill Lee of Franklin says he'd go one step further and make sure TennCare recipients have incentives to help the program save money, like prioritizing primary care over the emergency room.
In principle, Democrat Karl Dean, the former mayor of Nashville, says encouraging people to work is "not a bad thing" so long as the rules can be enforced "in a sensible way."
Rep. Craig Fitzhugh, D-Ripley, said he's fine with a work requirement, but contends the proposal is "a little deceiving" in Tennessee, since most of the 1.4 million TennCare recipients are pregnant women or children.
Republican businessman Randy Boyd of Knoxville is also concerned about creating piles of paperwork that might not save any money.
"When you start looking at how many people that are [on TennCare] because of disability or because they're pregnant or because they're children, you start to get to a fairly small number. And the cost of actually monitoring and maintaining that program might be more expensive than the problem itself," he said.
TennCare has done some math and decided there are too many variables to make an accurate prediction. But the agency estimates that fewer than 90,000 members would even need to prove they're working.
Question: Many states are applying for Medicaid waivers that impose working requirements on certain Medicaid program beneficiaries. How do you feel about work requirements for Medicaid beneficiaries and would you pursue such a waiver?
Beth Harwell: I am participating in that right now. We have a piece of legislation that I'm cosponsoring with some of my members that would go back to the federal government and allow us to have a work requirement for able-bodied [people]. Those people who do not have children under the age of 6, those that have no chronic conditions, to be able to work. We need to provide for those low-income people a safety net while they go through some difficult time. But it does not need to be — or turn into — a lifetime entitlement program. So those that are able-bodied should look for work. We currently are require it in our welfare program. We got that waiver under President Clinton. Now we have the ability to get the waiver under Trump, and so we are passing a piece of legislation to ask for that waiver.
Craig Fitzhugh: Frankly, the Medicaid program in Tennessee is the TennCare program, and we don't have able-bodied folks. We have disabled folks. The only able-bodied folks generally are pregnant women with children. So there's not a real requirement for the ability to work. So I think it's a little deceiving to do that. But the Medicaid population should have that. And I have an amendment to the speaker's bill that would add that on there. So I think it's important that able-bodied people do work, but our TennCare is not set up for that. So it would not affect us very much.
Karl Dean: I believe that having work requirements is not a bad thing. And if it can be made to work in a sensible way, and it doesn't discourage people from seeking medical attention, and it doesn't penalize people and become too much of bureaucracy, then fine. I think encouraging people to work is always appropriate. But I want to make sure that it is handled in the right way and doesn't end up creating more bureaucracy and more paperwork than it actually solves a problem.
Randy Boyd: I'm also in favor of work requirements, or at least looking at work requirements, but I think we do need to do the math and make sure that it makes economic sense. When you start looking at how many people that are there because of disability or because they're pregnant or because they're children, you start getting into a fairly small number. And the cost of actually monitoring and maintaining that program might be more expensive than the problem itself. So we get to make sure that it makes economic sense as well.
Bill Lee: I do believe that work requirements are a good idea, but I actually think we go further than that. Not in requirements, but what we need to do, we have this escalating cost of our TennCare program, and what we need to do is be certain that users of that program have some incentive to help us lower cost. Otherwise, nothing will ever change about the cost for that part of our health system. When you have a TennCare patient who has no incentive to go to a primary care provider in lieu of going to the ER, there's something wrong with that system. Or when you don't reward healthy behavior over unhealthy behavior, there's something wrong there as well. So I do think we need to go even deeper.