The Medicaid Experiment in Arkansas: Thousands Lost Coverage, Few Gained Jobs

This article (1) title makes you think that this isn’t good. How can a program that is supposed to help people end up hurting people? Arkansas devised a Medicaid work requirement, but a study (2) found that thousands of poor adults lost their health coverage without evidence that employment increased in the target population. This work requirement was described as backfiring as many lost coverage without the expected gain in jobs (3). A report (4) described that over 18,000 lost coverage in 2018 due to this Medicaid work rule. This means a large number of low-income people were kicked off the government funded insurance program due to work rule noncompliance in 2018. I first thought that such a work requirement isn’t that bad of an idea. Part of me fundamentally doesn’t see it as all that bad. Work is good. Health insurance is good. Losing health insurance is bad. How could this happen? The actual study can be found at (5) in the New England Journal of Medicine: “the requirement had only a limited chance for success as nearly 97% of Arkansas residents ages 30-49 who were eligible for Medicaid — those subject to the mandate — were already employed or should have been exempt from the new law (4)”

The researchers said the uninsured rate increased among 30- to 49-year-old Arkansans eligible for Medicaid from 10.5% in 2016 to 14.5% in 2018, while the employment rate fell from about 42% to just below 39%. “Lack of awareness and confusion about the reporting requirements were common, which may explain why thousands of individuals lost coverage,”(4).

Sources described a needed level of sophistication to be able to understand the work requirement anyway. “Considering that many who lost coverage due to the work requirement did not even know they were subject to the work requirement or understand what they needed to do to comply, I think it’s unlikely that those same individuals are aware of this detail in the complex policy (4)” Maybe a factor in the debacle is that the program wasn’t rolled out and marketed successfully. Maybe the program fundamentally isn’t a bad idea, but how it was run and implemented caused part of the problem. Many of the people were simply not aware of the program and requirements. Many were not aware of how to meet the requirements and how to report the work. Data suggest that many of those people may be working or qualify for an exemption but simply aren’t reporting the information to the state (4).”

Anyway, just a few things to ponder on this rainy Sunday evening. Have a good one. 


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Robert Duprey MD

Robert P. Duprey Jr studied medicine as a 2nd career medical student who went to medical school in his 40’s after honorable discharge and ‘retirement’ from 25 years in the US Military (USCG & US Army). He was a registered nurse (RN) with specialty training as a psychiatric RN in the US Army for 15 years. During this time he also became a Master’s level psychotherapist in 2002. While on US Army active duty he also became a Psychiatric Nurse Practitioner while working full time in 2011. He served as a Psych NP on active duty, to include a combat tour in Iraq, until his ‘retirement’ in 2014 and moved to Philippines with his 3 children. At this time he started medical school overseas at Oceania University of Medicine based out of Samoa accredited by Philippine Accrediting Association of Schools, Colleges and Universities (PAASCU). He continued to work as a Psych NP throughout medical school to support his children and to not have to take out loans for medical school tuition. Originally from Rhode Island, he completed medical school clerkship rotations throughout the USA with a graduation in May 2019 earning the esteemed credential of MD. He has successfully completed USMLE Steps 1, 2CS, and 2CK. He will take Step 3 this September as he applies for Psychiatry Residency. Having been and RN, NP and now MD, he is a believer of Physician led multidisciplinary healthcare teams