New Approaches In Medicaid: Work Requirements, Health Savings Accounts, And Health Care Access

Abstract

Alternative approaches in Medicaid are proliferating under the Trump Administration. Using a novel telephone survey, we assessed views on health savings accounts, work requirements, and private vs. public coverage. Our sample included low-income non-elderly adults (N=2739) in three Midwestern states with different policies: 1) Ohio, which expanded traditional Medicaid; 2) Indiana, which expanded using health savings accounts (“POWER” Accounts); and 3) Kansas, which has not expanded. We found that coverage and access to care in 2017 were significantly higher in expansion states than in Kansas. However, compared to Ohio’s traditional expansion, cost-related barriers were more common in Indiana. Among beneficiaries eligible for Indiana’s program, 39% had not heard of POWER Accounts, and only 36% were making their required payments, meaning that nearly two-thirds were potentially subject to loss of benefits or coverage. Meanwhile, in Kansas, 77% supported expanding Medicaid, with similar attitudes towards Medicaid or private insurance. 49% of potential Medicaid enrollees in Kansas were already working, 34% were disabled, and only 11% were unemployed and would seek work if required by Medicaid. These findings suggest that current