Bioethics for Breakfast: Medicaid Work Requirements: Blood, Sweat and Tears Too?

Bioethics for Breakfast Seminars in Medicine, Law and SocietyAdrianne Haggins, MD, presented at the Bioethics for Breakfast event on February 8, 2018, offering perspective and insight on the topic, “Medicaid Work Requirements: Blood, Sweat and Tears Too?” Leonard Fleck, PhD, moderated this session.

The Trump administration has proposed giving states permission to attach work requirements for Medicaid eligibility. So far, ten states are seeking that permission. Is this a good idea, either from an ethical perspective or a policy perspective? Our speaker, Dr. Adrianne Haggins, is part of a research team at the University of Michigan that evaluated the impact of Michigan’s Medical expansion on employment—as reported in JAMA Internal Medicine (Dec. 11, 2017)—as well as health, and healthcare utilization.

A researcher at Kaiser Health News has added, “States will have to figure out how to define the work requirement and alternative options, such as going to school or volunteering in some organizations; how to enforce the new rules; how to pay for new administrative costs; and how to handle the millions of enrollees likely to seek exemptions.” Dr. Haggins also discussed some of her own research regarding health disparities and emergency department utilization.

Audience participants questioned such things as the administrative costs associated with implementation as well as the value and accuracy of labeling individuals as able-bodied with its attendant underlying stigma of deserving/undeserving of medical care. It was noted that much of the national conversation is linked to racialized assumptions that those utilizing Medicaid benefits are largely persons of color. Finally, many audience members argued the point that all people unconditionally deserve access to health care and some observed how that point too often gets lost in the semantics.

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Adrianne Haggins, MD
Adrianne Haggins is a clinical assistant professor in emergency medicine at the University of Michigan Medical School, and alumnus of the MSU College of Human Medicine class of 2007. She is a member of a research team at the University of Michigan evaluating the impact of Michigan’s Medicaid expansion, the Healthy Michigan Plan, using a mixed-methods approach. This evaluation provides rich data on enrollee and health care provider experiences with the Michigan Medicaid program, as well as health care utilization. Dr. Haggins’ specific interests are related to examining the impact of health care reform on emergency department utilization.

About Bioethics for Breakfast:
In 2010, Hall, Render, Killian, Heath & Lyman invited the Center for Ethics to partner on a bioethics seminar series. The Center for Ethics and Hall Render invite guests from the health professions, religious and community organizations, political circles, and the academy to engage in lively discussions of topics spanning the worlds of bioethics, health law, business, and policy. For each event, the Center selects from a wide range of controversial issues and provides two presenters either from our own faculty or invited guests, who offer distinctive, and sometimes clashing, perspectives. Those brief presentations are followed by a moderated open discussion.