York lawmaker: Medical assistance recipients need 'bit of a kick' sometimes

Sometimes people on medical assistance need "a little bit of a kick" to get back to work, according to one York County lawmaker.

State legislation that would do that by adding work requirements to medical assistance programs recently passed the House and is on its way to the Senate.

"It would be wrong to allow people to languish in a broken system simply because we lack the political will to fix it," wrote primary sponsor Rep. Matthew Dowling, R-Fayette County, in a tweet Tuesday, April 17, after the bill cleared his chamber.

A Human Services Code amendment bill, HB 2138, passed the House 115-80 Tuesday, April 17, with support of all six York County Republican legislators.

Rep. Stan Saylor during the swearing-in ceremony at the Capitol in Harrisburg, Tuesday, Jan. 3, 2017. Dawn J. Sagert photo

Rep. Stan Saylor, R-York Township, said the state has seen a lot of success with similar ideas implemented during Gov. Tom Ridge's term in the 1990s — receiving good feedback from those who were on welfare programs at the time and returned to work.

"Sometimes people need a little bit of kick to keep moving," he said.

Budgeting: Saylor also noted that getting people back to work who are able will free up money to be used in areas where it's more needed, such as education and autism and senior support.  

"Every year we struggle with our budget," said Rep. Kristin Phillips-Hill, R-York Township. She said she wants to get assistance to those who really need it and do more with less. 

State Rep. Kristin Phillips-Hill talks about her career and women in politics at her Jacobus office Thursday, July 6, 2017. She represents the 93rd House District in the Pennsylvania House of Representatives. Bill Kalina photo

Rep. Dawn Keefer, R-Dillsburg, said the state's human services budget has grown 6 percent to 7 percent annually for the past few years, but the state's economy is only growing 2 percent to 3 percent annually over that same period.

"We need to be judicious with our resources," she said, making sure they go to the most vulnerable.

Rep. Carol Hill-Evans, D-York City, opposed the bill, saying she agrees with the idea of preventing people from taking advantage of medical assistance programs, but she believes efforts should be focused on finding root causes of the problem and fixing loopholes.

"I don’t want to pass any legislation that’s going to have a negative impact on our most vulnerable citizens," she said. "I’m in support of making sure that there is little to no fraud, but this legislation does not address that."

A similar bill, removing work requirement waivers for the Supplemental Nutritional Assistance Program, or food stamps, also is moving through the House and is expected to be up for a full vote the week of April 30, said Rep. Seth Grove, Dover Township.

Rep. Dawn Keefer, R-Dillsburg, during the swearing-in ceremony at the Capitol in Harrisburg, Tuesday, Jan. 3, 2017. Dawn J. Sagert photo

Phillips-Hill says the House will have 14 pieces of legislation related to safety-net programs heading to committees soon. 

Round two: It's not the first time a bill with work requirements has made its way through the state Legislature, Grove said when reached by phone Tuesday, April 17, before the vote.

A similar bill passed the House and Senate before it was vetoed by the governor last fall, but Grove is confident this bill will pass the Senate and be signed.

The Trump administration announced in January that states could now require "able-bodied" recipients to work, according to The Associated Press.

State Representative Carol Hill-Evans speaks as Southern Pennsylvania Incident Network (S.P.I.N.) holds a vigil in honor of fallen York City firefighters Ivan Flanscha, 50, and Zachary Anthony, 29, at Alexander D. Goode Elementary School in York City, Saturday, March 24, 2018. About 200 community members were in attendance. Dawn J. Sagert photo

More:Trump’s move might nudge holdout GOP states to expand Medicaid

More:Trump work requirement rewrites health care rules for poor

Pennsylvania hopes to be the next, following states such as Kentucky and Oklahoma.

According to Grove, the state Department of Human Services reports that of the state's 2.3 million medical assistance recipients, 495,000 are able-bodied.

If each person worked at least 20 hours a week at $10 per hour, it would bring in $158 million in personal income tax revenue and about $5.1 billion in economic activity, he said, adding that sales tax purchases could drive up revenue generation to well over $200 million.

Pennsylvania State Rep. Seth Grove reacts to Gov. Tom Wolf's 2017-18 budget address at the Pennsylvania State Capitol in Harrisburg, Tuesday, Feb. 7, 2017. Dawn J. Sagert photo

Back to work: "There’s so many open jobs in Pennsylvania right now," Grove said.

The goal of the legislation, he said, is getting people back to work.

The state's bill would require work for individuals who are not exempt for the following circumstances:

  • Attending high school full time.
  • Receiving temporary or permanent long-term disability benefits.
  • Younger than 19 or 65 and older.
  • Pregnant women.
  • Receiving supplemental security income benefits.
  • Residing in a mental health institution or correctional institution.
  • Experiencing a crisis, serious medical condition or temporary condition that prohibits employment, including but not limited to domestic violence or a substance use disorder.
  • Primary caregiver to a dependent younger than 6.
  • Primary caregiver to an individual who is permanently disabled or in hospice care.

According to the bill, working 20 hours a week or completing 12 job-training program-related activities a month will fulfill the requirements. 

The penalty for not adhering to those terms is a loss of benefits, which increases each year — three months without benefits in the second year of enrollment, six months in the third year and nine months in the fourth year.

Phillips-Hill says the bill legislators passed has the maximum number of exemptions allowed under federal law.  

Contentions: Marc Stier, director of the Pennsylvania Budget and Policy Center, wrote an op-ed in advance of the House vote, laying out potential concerns with the medical assistance and SNAP bills.

Marc Stier

More:OPED: 'Work requirement' bills are a cruel election-year ploy

One concern was that those benefiting from medical assistance programs are already working or have a worker in the family.

According to the Henry J. Kaiser Family Foundation — a nonprofit and nonpartisan organization focused on national health issues — 64 percent of Medicaid recipients in the state are working at any one time.

Seventy-nine percent of those on Medicaid and 74 percent using SNAP have a worker in the family, according to the foundation.

Keefer says the information she got from the Department of Human Services showed that about 50 percent of Pennsylvania residents on medical assistance were able-bodied.

If the Human Services Department numbers are correct, she said, but it's also true that about 60 percent of recipients are working, it would be troubling because it would mean more than 10 percent of disabled recipients are working.

Stier also cited statistics from the Center on Budget and Policy Priorities and the U.S. Census Bureau that show safety net program recipients often work in fields of unstable employment.

Grove said the bill's exemptions account for those facing a number of circumstances, including those working cyclical jobs, such as construction workers.

On the Kaiser data, he said he has not seen the reports, but he would rather rely on state data than a national look because it's more accurate and in tune with Pennsylvania.

In this March 28, 2017 file photo, the Kansas Senate votes to expand KanCare, the state's Medicaid program. The Trump administration’s embrace of work requirements for low-income people on Medicaid is prompting lawmakers in some conservative holdout states to reconsider expanding the program. (Thad Allton /The Topeka Capital-Journal via AP)

Other Republican legislators, including Phillips-Hill, agreed, saying it's difficult to compare national statistics with statewide statistics because every state is very different, and she does not know what the sample size is across the country.

Costs: Stier said he believes the state will lose money from administrative and support costs.

Since the federal government supports the majority of these programs now, he wrote, tens of millions of dollars would be needed to administer them, as well as hundreds of millions of dollars needed to provide work and other supports.

Grove disagrees, saying costs will be far less when aligned with existing work requirements, as recommended by the federal government.

"(We're) not reinventing the wheel," he said. 

Saylor says the state's plans include providing child care and job training from existing programs.

Hill-Evans recommended examining costs to find out if it makes more fiscal sense to fix the existing system or to shell out more money on administrative costs for the state.

Republican legislators say it's hard to accurately measure how much money the state will make from introducing work requirements and whether or not that will exceed additional administrative costs because there are a lot of factors to consider.

When you do an analysis, Phillips-Hill said, you need to include the budgetary impact of those who would be employed and paying income and sales taxes.

"What is the price of someone becoming independent and able to live a life not dependent on government?" she added. 

According to the bill's fiscal note, the state estimates administrative costs, including providing services to assist recipients in finding work and obtaining child care and transportation, to be $27 million. 

The note states about 438,000 people are estimated to be subject to work requirements, not including those with disabilities, those who already fulfill work requirements through Temporary Assistance to Needy Families and an estimated 20 percent of able-bodied recipients who would be exempt because of a crisis or other condition.