This editorial was published by the Post Register of Idaho Falls


A recent study published in the New England Journal of Medicine provides considerable evidence that Medicaid work requirements, even if they sound good on paper, are in practice simply an architecture of cruelty that produces no discernible positive effects, simply a lot of pain.

The study, which involved surveying thousands of people in the Medicaid expansion-eligible population in Arkansas and three similar states without work requirements, found that about a third of those subject to work requirements had no idea there were requirements, and nearly half didn’t know whether the requirements applied to them. And about one-third said they didn’t have internet access, so they were unable to meet the reporting requirements even though 95 percent of them met the actual work requirements. That’s partly because Arkansas, like Idaho, has a significant low-income rural population.

The result was thousands of Arkansans losing the coverage they qualified for, not because they refused to work, but because the complicated bureaucracy lawmakers had constructed was simply too difficult for struggling low-income families to navigate.

There must be some upside. The reason for work requirements is to encourage people to work, so certainly more Arkansans gained employment as a result of the policy, right?

But there’s no evidence of that happening. The study found that the work requirement wasn’t associated with any increase in employment. In fact, during good economic times, employment in the group targeted by work requirements declined slightly.

This is the model Idaho lawmakers decided to follow earlier this year.

Lawmakers can’t say they weren’t warned about this. A survey of Idaho doctors found 93 percent were opposed to work requirements, favoring instead clean Medicaid expansion, and many testified against the proposal during the legislative session. The Idaho Hospital Association vigorously opposed work requirements. So did hundreds of regular citizens who descended on the Capitol. This editorial board warned repeatedly that exactly this outcome was likely.

Lawmakers never bothered to publicly produce any empirical evidence that their plan was likely to be effective. That’s because it wasn’t an exercise in wise policymaking, but largely an exercise in political rear-end covering. Lawmakers do not perceive a political threat resulting from ignoring their voters and harming their constituents — but the possibility of a primary challenge? That’s the sort of crisis that demands action.

This cruel architecture is going to cost you, the taxpayer. The fiscal note attached to the bill creating work requirements estimated it would cost $1.6 million per year to run the bureaucracy, but the cost is likely to be higher than that. Idaho lawmakers refused to eliminate the Catastrophic Health Care Fund and county indigent funds, which cover the hospital bills of those who can’t afford to pay them. No effort was made to estimate those costs.

So first you’ll pay to kick hundreds of working people off the Medicaid rolls — somewhere around 1,000 of your neighbors if the Arkansas experience holds true in the Gem State — and then when they show up in the ER because a treatable condition has escalated into an emergency, you’ll pay again. And they’ll have a lien against their home, land and personal property, and in many cases be left medically unable to work. How can anyone be expected to recover economically from a situation like that?

If lawmakers had done nothing but what the voters instructed, that person would remain on the rolls, get regular health care to avoid an emergency, and the feds would pick up most of the bill. And remaining healthy would allow that person to work, making the arduous climb out of poverty without losing what assets they still have to their name.

The Department of Health and Welfare, which is now bound by state law to build this cruel bureaucracy, is currently accepting public comment to help shape the system. You can make your voice heard by sending your thoughts to

And in November of next year, when you’re considering who to vote for, remember that every lawmaker within the Post Register’s 10-county coverage area, with the sole exception of Sen. Mark Harris, supported this law.

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