Drug testing: Needless, costly, burdensome

To assure access to health care, drug testing just gets in the way

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.[1] In most states, less than 1 percent of applicants have tested positive.[2]

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.[3] 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.[4]

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.[5]

Medicaid plays a vital role in insuring more than 260,000 Iowa children.[6] 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.[7]

Over 225,000 Iowans living in working households struggle to make ends meet.[8] 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.[9]

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.

 

[1] 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

[2] 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

[3] Ibid.

[4] 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/

[5] 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/

[6] 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

[7] Center on Law and Social Policy, “Drug Testing and Public Assistance.”

[8] 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

[9] 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/

 

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Natalie Veldhouse is a research associate for the nonpartisan Iowa Policy Project. nveldhouse@iowapolicyproject.org

Boost work: Keep Medicaid accessible

Complicating Iowans’ ability to get checkups and the medications they need will not improve workforce participation.

Iowa’s Medicaid program carries two major purposes. First, Medicaid provides medical care for the elderly; in fact, 44 percent of Medicaid spending goes for long-term services and supports for seniors.[1] About half of Iowa nursing home residents benefit from Medicaid.[2]

Second, Medicaid covers thousands of Iowans working in low-wage jobs with no health insurance benefits and to thousands of others who have a disability that prevents them from working. Nearly half of all Medicaid recipients in Iowa are children.[3]

The data show that Medicaid is an important work support. Most non-elderly adult Medicaid enrollees in Iowa work — 72 percent — and 87 percent live in a working family.[4]

Among Medicaid enrollees in Iowa, larger shares of African-American and Latino enrollees are working than whites. One-third of Iowa working Medicaid enrollees work in smaller companies, which likely do not provide employer-sponsored insurance. It might surprise Iowans to know the largest group of Iowa workers receiving Medicaid work in elementary and secondary schools.[5]

Imposing new requirements for Medicaid would complicate health-care access for low-wage workers, children, veterans, older Iowans and Iowans with disabilities. It would not improve workforce participation.

Contrary to some political claims, studies in case after case show the main impact of extra Medicaid requirements is not better jobs,[6] but disenrollment in Medicaid, worse health outcomes, less access to care, and financial insecurity.[7] Rather than promoting good health that is important for employment and productivity, added Medicaid eligibility requirements undermine the goal of encouraging work.

If policy makers’ goal is to increase workforce participation, more practical approaches exist in expanding the state Earned Income Tax Credit and Child Care Assistance eligibility.

Not only do new Medicaid requirements fail to encourage work, but they make sustaining coverage difficult for people who are exempt from work, such as Iowans with disabilities, who may face obstacles in documentation and verification. Workers with variable hours, particularly in food service, retail, and seasonal jobs, could face similar issues.

Many working Medicaid enrollees work full time, but their low annual wages still quality them for Medicaid.[8] Rural communities rely heavily on Medicaid; disenrollment could harm rural hospitals and restrict access to care for children, the elderly, and veterans.[9]

It makes no sense to restrict access to health care for Iowans who are working or are exempt due to age or disability status.

 

[1] Steve Eiken, Kate Sredl, Brian Burwell & Angie Amos, “Medicaid Expenditures for Long-Term Services and Supports in FY 2016.” Table 31. Iowa LTSS Percentage Trends. https://www.medicaid.gov/medicaid/ltss/downloads/reports-and-evaluations/ltssexpenditures2016.pdf

[2] Kaiser Family Foundation, “Medicaid’s Role in Nursing Home Care.” Table 1: Medicaid’s Role in Nursing Home Care, by State.  June 2017. https://www.kff.org/infographic/medicaids-role-in-nursing-home-care/

[3] American Community Survey, “Health Insurance Coverage Status and type of Coverage by State and Age for All People: 2017.” Table H105. September 2018. U.S. Census Bureau. https://www.census.gov/data/tables/time-series/demo/income-poverty/cps-hi.html

[4] 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/

[5] Ibid.

[6] LaDonna Pavetti, “Work Requirements Don’t Cut Poverty, Evidence Shows.” June 2016. Center on Budget and Policy Priorities.  https://www.cbpp.org/research/poverty-and-inequality/work-requirements-dont-cut-poverty-evidence-shows

[7] Hannah Katch, “Medicaid Work Requirements Will Harm Families, Including Workers.” February 2018. Center on Budget and Policy Priorities. https://www.cbpp.org/research/health/medicaid-work-requirements-will-harm-families-including-workers

[8] Ibid.

[9] Center on Budget and Policy Priorities, “How Medicaid Work Requirements Will Harm Rural Residents – And Communities.” August 2018. https://www.cbpp.org/research/health/how-medicaid-work-requirements-will-harm-rural-residents-and-communities

 

Natalie Veldhouse is a research associate for the nonpartisan Iowa Policy Project. nveldhouse@iowapolicyproject.org

Stewardship, community and freedom

The assault on our public structures by convenient, slick, political messages of the day defies American values of stewardship and community.

Today America faces a daunting task: finding a way to reduce deficits and debt while not crashing the economy and still maintaining the critical services that are only, or best, provided by the public sector.

At the Iowa Policy Project, we have the opportunity to work with many similar state and national organizations — nonpartisan, nonprofit, issue-focused and fact-based analysis at the heart of their missions and their work. One of these colleagues, Michael Lipsky, distinguished senior fellow at Demos, recently wrote a column in The New York Times about a hiking trip in the Pasayten Wilderness in Washington state, near the Canadian border.

In his excellent piece, “A Well-Regulated Wilderness,” Lipsky wrote that, even there, he found himself thinking about government. “Not that there was much of it in sight,” he remarked. He continued:

There were no rangers to check our reservations, no posted rules telling us where and how to set up camp.

Michael Lipsky, distinguished senior fellow, Demos
Michael Lipsky, Demos

If anything, the Pasayten seemed to prove that we don’t need government, that humans can be self-regulating: per the unofficial rules of backpacking, most of our campsites had been reused repeatedly, to minimize damage to the environment, and litter was rare.

On reflection, however, this nursery of freedom spoke directly to the role of government in shaping our world. It was thanks to decades of effective lawmaking that we could enjoy four days in the open country, fixing meals, hiking and spending family time together. … Americans once feared the wilderness and sought to tame it. Now we seek it out as redemptive. …

In 1964 Congress passed the Wilderness Act, which set aside 9.1 million acres of public land as places where people would be visitors but not leave any marks; today some 108 million acres are protected under the act.

Mike Owen
Mike Owen

Michael Lipsky’s perspective is spot-on. Let’s look at it another way: Would Exxon have done this? Or Microsoft? Or Wal-mart? Would it even make sense for them, or their stockholders, to do so? To whose mission, then, do such responsibilities fall? Does it not make sense that this would fall to the federal government? Would you not say the same about basic economic safety-net programs? Infrastructure such as roads and bridges? Workplace safety? Clean water and clean air protection? Civil rights and education? National security?

The assault on our public structures by convenient, slick, political messages of the day not only disregards, but defies, what in our hearts and minds we know are the American values of stewardship and community that are the thrust of what government does.

We’re all concerned about deficits and debt and the impact on our children and grandchildren, but we also must be challenged to address the impact on those future generations of a failure to accept the mantle of responsibility of maintaining and nurturing the structures that have sustained us, when “self-regulation” is not enough. For if we do fail on that score, it will be every bit as much a debt as one of dollars.

Posted by Mike Owen, Assistant Director