You could say we all saw this coming because we discussed this exact possibility earlier this year.
Kentucky Governor Matt Bevin's plan to impose new requirements on people participating in the expanded Medicaid program under Obamacare required the state government to create a whole new bureaucracy to track and implement the requirements across the state.
And this new system included more than just work requirements. Bevin's new bureaucracy also included a "rewards points" program that rewarded people for 'good behavior' by granting them access to services they would otherwise qualify for under normal circumstances anyway, like dental and vision care.
As you might imagine, building a computer system and employing people to track these things in every district and at every health care provider in the state is a tall, expensive order and, in fact, the Kentucky has seen its administrative costs soar by 40 percent according to Fitch Ratings.
“In its biennial budget, Kentucky’s Medicaid administration costs increased more than 40%, or $35 million, from prior biennium to $116 million, which Fitch partially attributes to implementing Medicaid work requirements,” Eric Kim, the lead analyst for Fitch on the report, “Medicaid Waiver Actions Limit U.S. States’ Cost Controls,” wrote. “In addition to systems development and ongoing monitoring for the roughly 200,000 Medicaid enrollees, Kentucky estimates could be subject to the work requirements and could also contribute to the higher administration costs.”
In a roundabout way, you might say the recent court ruling against Bevin's program -- a program designed to save the state money -- will still save the state a lot of money because administrative costs will decrease.
According to analysts at Fitch Ratings, it's possible the increased administrative cost of building and running requirement programs will always cost as much or more than they could ever save by kicking people off the rolls.
They expect other states will see the same results if they implement new requirements because they will also have to build new systems to track and implement it.
If other states pursue Medicaid work requirements, they may reduce costs by knocking more patients off their Medicaid rolls and increasing the number of uninsured in their states. But savings from spending less to cover poor people will be a wash, according to the Fitch analysis.
“Direct costs for Medicaid work requirements could limit savings from enrollment declines,” Fitch Ratings report said. “Work requirements require tracking systems that few, if any, states have."
If we're being real, Bevin and other conservatives probably see this as a small price to pay.
Even if implementing new requirements costs as much or more than they would save by kicking people off the rolls, they may consider it an acceptable price for conservative social engineering.
If the real goal is to just kick people off the rolls at any cost, none of this will dissuade them. We already know the human cost doesn't dissuade them.