Multiple bills introduced in the 2019 Iowa legislative session would limit access to health care by posing bureaucratic hurdles to working families needing help.
Drug-testing Medicaid recipients is one of those ideas. Already shown to be costly and ineffective in other states, the idea is one more solution in search of a problem. Studies show that drug use among work support recipients is lower than the general population. In most states, less than 1 percent of applicants have tested positive.
Neighboring Missouri provides a lesson for Iowa on cost. Missouri spent $336,297 on drug testing of Temporary Assistance for Needy Families (TANF) in 2017. After initial screening, the state tested 108 of 32,774 TANF applicants, finding 11 positive results. That’s an investment of over $30,000 per positive test. Another 305 applicants did not show up for a drug test or refused to take one.
Iowa is familiar with these costs. Last session, a similar bill was proposed to implement drug testing for SNAP and Medicaid recipients. A Department of Human Services administrator estimated that costs to the state would have been at least $100 million.
Medicaid plays a vital role in insuring more than 260,000 Iowa children. Restricting access to medical care through drug testing poses a threat to child well being, by reducing resources available to the household as a whole.
Over 225,000 Iowans living in working households struggle to make ends meet. Medicaid and Affordable Care Act subsidies are important work supports that help families get by when wages aren’t enough to cover basic costs.
In Iowa, the large majority of Medicaid recipients who can work do work. Eighty-seven percent live in a working family and 72 percent work themselves.
Instead of making it more difficult for low-income families to get the medical care they need, Iowa can invest in its workers by expanding the state Earned Income Tax Credit and Child Care Assistance programs. Other alternatives include raising wages to more accurately reflect workers’ productivity and higher living costs, or adequately funding mental health care.
 Center on Law and Social Policy, “Drug Testing SNAP Applicants is Ineffective and Perpetuates Stereotypes.” July 2017. https://www.clasp.org/sites/default/files/publications/2017/08/Drug-testing-SNAP-Applicants-is-Ineffective-Perpetuates-Stereotypes.pdf
 Center on Law and Social Policy, “Drug Testing and Public Assistance.” February 2019. https://www.clasp.org/publications/fact-sheet/drug-testing-and-public-assistance
 Amanda Michelle Gomez and Josh Israel, “States waste hundreds of thousands on drug testing for welfare, but have little to show for it.” May 2018. Think Progress. https://thinkprogress.org/states-waste-hundreds-of-thousands-on-drug-testing-for-welfare-3d17c154cbe8/
 O. Kay Henderson, Iowa Senate bill to require drug tests, work for welfare.” February 2018. Radio Iowa. https://www.radioiowa.com/2018/02/15/iowa-senate-bill-to-require-drug-tests-work-for-welfare/
 American Community Survey, “Health Insurance Coverage Status and Type of Coverage by State and Age for All People: 2017. September 2018. U.S. Census Bureau. https://www.census.gov/data/tables/time-series/demo/health-insurance/acs-hi.html
 Center on Law and Social Policy, “Drug Testing and Public Assistance.”
 Peter Fisher and Natalie Veldhouse, “The Cost of Living in Iowa 2018 Edition Part 2: Many Iowa Households Struggle to Meet Basic Needs.” July 2018. Iowa Policy Project. http://iowapolicyproject.org/2018Research/180702-COL-Part2.html
 Rachel Garfield, Robin Rudowitz, & Anthony Damico, “Understanding the Intersection of Medicaid and Work.” January 2018. Kaiser Family Foundation. https://www.kff.org/medicaid/issue-brief/understanding-the-intersection-of-medicaid-and-work/
Natalie Veldhouse is a research associate for the nonpartisan Iowa Policy Project. firstname.lastname@example.org