Denying health coverage: fresh blow to low-income workers

Iowa was among the early states to expand Medicaid to low-income adults under the Affordable Care Act. The 2013 decision made it possible for thousands of Iowans to see a doctor, get medications and go to the hospital without having to choose between paying medical bills or paying the rent.

Now the governor and some lawmakers want to reverse Iowa’s coverage gains. Empowered by the new presidential administration, they want to add new layers of red tape by requiring Iowa Medicaid adult enrollees to report work hours to the state to keep their insurance.

No one thinks it’s a bad idea for people who can work to do so. But ramping up the red tape required for people to stay insured simply won’t get us closer to that shared goal.

In reality, most people on Medicaid who can work are already working— in low-wage jobs with no benefits. Most of those not working are caring for loved ones or dealing with serious health challenges. Like many Iowans with low incomes, people on Medicaid are more likely to move frequently, have unreliable internet access and face other barriers to meeting complex verification requirements.

The experiences of other states are instructive:

It’s worth noting that Iowa HHS is not expected to meet a July 2025 deadline to launch information systems for a set of public-assistance eligibility requirements lawmakers approved two years ago. How ready is it to regularly track work hours for thousands of Medicaid members?

If this was really about jobs, Iowa lawmakers would do more to help people trapped at the bottom of our inequitable economy, not punish them for being poor.

We would increase the minimum wage, stuck at $7.25 for 17 years, and make it easier for low-wage workers to collectively bargain for wages and benefits. We would double our efforts to make affordable child care more available. We would expand the state’s respected PROMISE JOBS program that helps people overcome barriers to employment. We would help school districts pursue innovative career and technical education and cut college tuition to pave an easier path to higher-wage careers.

Helping people who can work find decent work is good for families and good for Iowa's economy. But taking health coverage away from people who don’t meet a rigid work-reporting requirement won’t help them further their careers. It will just make their lives harder.

Anne Discher is executive director of Common Good Iowa, a nonpartisan policy research and advocacy organization based in Des Moines. Contact: adischer@commongoodiowa.org.