No one knows better than Josh Hawley that ‘work requirements’ are Medicaid cuts

U.S. Sen. Josh Hawley speaks to reporters at the governor’s ham breakfast at the Missouri State Fair in Sedalia on Aug. 15, 2024 (Annelise Hanshaw/Missouri Independent)

U.S. Sen. Josh Hawley is presenting himself as the rare Republican willing to fight for low-income Americans who will lose their health care or food assistance if his party makes massive cuts to Medicaid and SNAP. He has been rewarded with much credulous reporting suggesting he is sincere about that.

But as Missouri’s senior U.S. senator and former attorney general, it’s fair to expect Hawley to know what is happening on the ground here: an abject failure to administer federal benefits in compliance with current law.

There is absolutely no possibility that Missouri can handle additional red tape like the “work requirements” in both the House and Senate versions of Republicans’ “Big Beautiful Bill,” yet Hawley has endorsed them.

Missouri just isn’t capable of enhanced eligibility requirements. A lawsuit brought by disabled Missourians who were denied SNAP benefits, formerly known as food stamps, proves this.

One plaintiff with cancer and COPD, lacking internet access, transportation — and, let’s not forget, food — used her prepaid cell phone minutes sitting on hold for days trying to get an application. When she gave up and paid for a ride to a benefits office, she got an application but couldn’t complete the required interview due to lack of staff. So she spent more days on hold before having her application denied for failure to complete the interview that she couldn’t get.

That lawsuit was filed when Hawley’s fellow senator from Missouri, Eric Schmitt, was our attorney general. Instead of fixing the problem, the state has defended the lawsuit for three years.

When the court found that Missouri was not complying with the law, current Attorney General Andrew Bailey appealed a non-appealable order that merely requires monthly progress reports on call wait times. In January of this year, the lowest daily average call wait time was 58 minutes and the highest average was 2 hours. The maximum wait time was 5 hours, roughly 21,000 calls were dropped and 14,134 callers gave up (or ran out of cell phone minutes, or had to pick up their kids, or had to go to work, etc).

On the Medicaid front, Missouri was investigated and offered support by the Biden Administration to deal with our worst in the nation, legally non-compliant wait times for enrollment.

Individuals submitting their renewal information — online, in person, by fax, or even certified mail — regularly lose their coverage automatically because the state fails to process their documents in time.

A woman who already had coverage through MO HealthNet, Missouri’s Medicaid program, went months without prenatal care because she was unable to reach anyone to tell them she was pregnant.

When the pandemic freeze on Medicaid disenrollments expired, Missouri made a mess of the eligibility review process so families learned at the pediatrician’s office that their children had lost their health insurance despite still being eligible. Children who went without medications for manageable conditions like asthma ended up at emergency rooms.

Now imagine everyone has to navigate a dysfunctional system every six months to keep their health insurance as both versions of the bill would require. Or even once a month – as the bills would allow.

You have to take time off work to prove you are working. Or you have to use up time and cell phone minutes to try to prove you can’t work and qualify for an exemption. In a system as broken as Missouri’s, many people can’t jump through those hoops even when they treat it like a full time job.

If Missouri can’t or won’t run it’s SNAP program properly under current law – where the federal government pays all of the benefits and 50% of the cost of administering those food aid dollars that go straight into our local economies – there is no way food insecurity here won’t get significantly worse and our economy won’t take a serious hit with Republicans’ planned cuts.

Those proposed cuts include states losing at least 5% and up to 25% of their SNAP dollars depending on their “error rate” of under and over payments to households with SNAP.  Missouri’s most recent error rate is 10.2%, which means we would lose 25% of our funding for being over 10%, like the majority of states. And the bill would also cut funding for administrative costs which will inevitably make our error rate worse. SNAP is an optional program, and I wouldn’t put it past our legislature to end it all together and let people starve.

As to Medicaid, instead of allocating the funding needed to run MO HealthNet properly, our legislators blame leadership issues or technology problems. Our legislature has done nothing to prepare for what the proposed Trump cuts would do to us, nor what the DOGE impoundments are already doing. They just keep passing tax cut after tax cut.

Given we are not currently capable of running our Medicaid or SNAP programs, there is no possibility that we can manage added expensive red tape.

But that’s the goal. Republicans know, because it has been widely documented, that work requirements don’t work even in more functional states. They don’t increase employment because people with Medicaid who can work are already working.

(I am setting aside the larger undiscussed issue of why working full time in the U.S. is not enough to afford health care, unlike in peer nations.)

The idea that there is $880 billion, or even a fraction of that, in “fraud, waste, and abuse,” in Medicaid is ridiculous. The savings Republicans are counting on would come from deliberately making it too burdensome for the struggling people these programs were intended to help to continue using them.

Look at Arkansas. The state implemented a work requirement and 18,000 people lost their insurance in the few months before a court determined the requirement had been illegally implemented.

Georgia enacted a program in lieu of Medicaid expansion that requires monthly eligibility paperwork. It has enrolled only 3% of Georgians with qualifying incomes, and the money spent on verifying eligibility has dwarfed that spent on providing actual medical care.

Republicans are counting on this happening on a much larger scale to offset their tax cuts. It’s an incredibly wasteful and dangerous strategy.

We burn money on processes to root out non-existent “fraud.” Then, when the people least equipped to navigate those processes can’t do so, they will lose their preventative health care and end up sicker and resorting to more expensive care at hospitals that are required by law to treat them regardless of ability to pay. Then all our premiums go up.

In Missouri, cuts will exacerbate our existing shortage of healthcare providers as more rural hospitals shutter due to lack of funds.

Hawley acknowledged that Missouri’s rural hospitals are in trouble when he opposed a different provision inthe House bill, which would curtail a Republican-created and very popular state tax used to get federal Medicaid dollars to hospitals. (He has since caved on the House’s curtailment, and now only opposes the Senate’s significantly more drastic one.)

Rural Missourians will have particular difficulty navigating the work requirement due to lacking internet access, transportation, and job opportunities. And you know what makes it harder to keep a job? Losing your health insurance so you can’t manage your health conditions.

Despite there being no universe in which Missouri becomes capable of administering additional eligibility requirements anytime soon, Hawley doesn’t even object to Republicans moving the implementation deadline up from 2029 to next year. This is not a serious proposal for a functioning eligibility process. It’s a plan to take insurance from eligible people on purpose.

When Hawley was asked last week about people “inadvertently losing coverage,” he said: “We can sort that out.” How? If it’s so easy to sort, why didn’t Hawley or Schmitt sort it out when they were state officials or since?

Hawley is portraying himself as an advocate for the people by using the Trumpian tactic of telling us that up is down and a cut is not a cut.

Presuming Hawley knows anything about the reality in Missouri, he knows better.

Missouri Independent is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Missouri Independent maintains editorial independence. Contact Editor Jason Hancock for questions: info@missouriindependent.com.