Thousands Lose Coverage Because of Medicaid Work Requirements
In January 2018, federal officials released guidance on instituting Medicaid work requirements—an unprecedented move for the low-income health program. A year later, work requirements are pending or approved in more than a dozen states, advocates are fighting the rules in court, and thousands have lost health coverage. The loss has mostly been because of lack of proper reporting by Medicaid participants.
Life expectancy in US men has fallen to 76.1 years, partly owing to deaths of despair.
Photo by Digitalskillet, courtesy iStockphoto.
Work requirements “put greater burdens on low-income workers—many . . . [of whom] will fall through the cracks, become uninsured, not be able to manage their health conditions and be less able to keep a job,” Emily Beauregard, MPH, executive director of Kentucky Voices for Health, told The Nation’s Health.
As of the new year, Kentucky was 1 of 7 states—along with Arkansas, Indiana, Maine, Michigan, New Hampshire, and Wisconsin—to receive approval from the Centers for Medicare and Medicaid Services to move forward with Medicaid work requirements. Another 8 states—Alabama, Arizona, Mississippi, Ohio, Oklahoma, South Dakota, Utah, and Virginia—were still waiting for approval.
Work requirement proposals vary from state to state, targeting both Medicaid expansion and nonexpansion populations, but the overall gist is the same: to make Medicaid coverage for low-income adults—with the exception of pregnant women, people 65 years and older, and those receiving disability benefits—contingent on meeting and reporting a certain number of work hours each month. In Arkansas, which was the first to begin Medicaid work requirements last summer, nearly 18,000 people have lost health coverage as of late 2018.
According to the Kaiser Family Foundation, if work requirements were imposed nationwide, between 1.4 million and 4.0 million people could lose coverage.
—Kim Krisberg
To read the full story, visit http://thenationshealth.aphapublications.org/content/49/1/1.3.
Suicide and Opioids Tied to an Ongoing Fall in US Life Expectancy: Third Year of Drop
US life expectancy continues to decline, with high mortality rates largely fueled by suicide and drug overdoses—growing public health crises that reflect deficiencies across many social determinants of health.
In November, the National Center for Health Statistics published data briefs on 3 critical trends in public health: US life expectancy declined to 78.6 years in 2017 from 78.7 years in 2016; the rate of drug overdose deaths, largely driven by opioids, was 9.6% higher in 2017 than 2016, and 3.6 times the rate in 1999; and from 1999 to 2017, the suicide rate increased 33%.
The findings were particularly alarming to the public health community because it is the third year in a row that US life expectancy has dropped. Life expectancy among women remained the same in 2017, at 81.1 years, but in men fell from 76.2 years to 76.1 years.
Meanwhile, a study published in October in the Lancet found that US life expectancy is projected to increase 1.1 years to 79.8 years in 2040, but the United States will drop in rank to 64th among 195 countries.
Deaths from suicide and opioid overdose fall in the category of deaths of despair: breakdowns in social determinants of health that lead to mortality.
An article published in December in AJPH illuminated just how deep the problem runs, with downturns in life expectancy and certain measures of well-being identified as early as 1980. Numerous factors can be attributed to declining life expectancy, according to the article, with failures in democratic institutions and regulations, economic stagnation, and increasing medical costs cited.
—Julia Haskins
To read the full story, visit http://thenationshealth.aphapublications.org/content/49/1/1.2.