Louisiana’s Office of Technology Services shut down computer systems across many government agencies yesterday in response to a cyber attack. The move was a necessary inconvenience, reports Sam Karlin in the Advocate, stopping the office of Motor Vehicles from issuing new driver’s licenses and preventing the Department of Children and Family Services from accepting new electronic SNAP applications. But as this interruption illustrates, government technology is an essential piece of public infrastructure, and investments in smoothly functioning technology matter greatly. This is particularly true for the more than 37,000 Louisianans who apply for SNAP in an average month, and the thousands of others who rely on the state’s computer systems to keep their families connected to health care and other benefits. Sonal Ambegaokar, Rachael Podesfinski and Jennifer Wagner, from the Center on Budget and Policy Priorities, explain how investments in government tech can make a difference in people’s lives:
For technology to be effective, it must focus on the user — both clients seeking critical benefits to support their families and eligibility workers handling overwhelming caseloads with inadequate resources. Technology must also be considered as part of the broader eligibility and enrollment process, in conjunction with policies and operations. Technology alone isn’t the solution to the challenges outlined in this report, but can be a critical part of a solution when combined with changes to other parts of the process.
Medicaid is popular
Many pundits have tried to cast Louisiana’s gubernatorial election as a referendum on President Donald Trump. But as The Washington Post’s Greg Sargent argues, policy issues also played a role in Gov. John Bel Edwards’ win – including his signature health care achievement.
The Medicaid expansion was not perceived by Louisiana voters as primarily an issue involving the urban poor or minorities. Indeed, (pollster Zac McCrary) said, it was seen as a positive selling point for Edwards among the moderate and suburban whites whose alienation from the Trump-era GOP is so often discussed these days. “This was universally popular with all the groups that are part of the Edwards coalition,” McCrary told me, adding that this was the case in part because many beneficiaries are working. “Everybody has a horror story about health care costs, including in these suburban areas.” The result, McCrary said, is that “even in these deep-red states, Medicaid is approaching the popularity of Medicare and Social Security,” and isn’t perceived as “some type of welfare program.”
Medicaid work requirements are not.
One other takeaway from recent elections: while Medicaid is popular, policies that force Medicaid recipients to report a certain number of work hours per month or to lose their benefits are not only counterproductive, they’re also unpopular. Joan Alker of the Georgetown Center for Children and Families argues that voters are pushing back against politicians who choose to impose harsh reporting requirements on people who get their health coverage through Medicaid, and politicians are pulling back from those policies in the face of high costs and effective legal challenges.
I have been saying for some time that work requirements are a terrible idea. They don’t achieve the purported goal of supporting employment but, as we saw in Arkansas, they are very successful in kicking people off of their health insurance. 23% of those affected in Arkansas lost their coverage in short order. A state has to incur large administrative costs and lawyer’s fees. A recent report from the Government Accountability Office highlighted these administrative costs, and in a really interesting finding suggested that CMS may be inappropriately approving some of the federal funds going to this flawed endeavor. They don’t comport with the objectives of Medicaid – which is to provide health insurance – not to take it away.
In public benefits, error does not equal fraud
Critics of public programs like SNAP and Medicaid often cite program “error rates” to argue – inaccurately – that those programs are beset by fraud. As Jessica Schubel of the Center on Budget and Policy Priorities points out, however, error and fraud are not the same thing, and politicians and advocates should be careful to avoid conflating the two in arguments about the programs that keep people healthy and fed.
The Centers for Medicare & Medicaid Services (CMS) will soon release the 2019 Payment Error Rate Measurement (PERM) rate, which measures “improper” payments in Medicaid and the Children’s Health Insurance Program. But contrary to how they’ve been represented, these rates measure state procedural mistakes — they don’t necessarily mean a beneficiary did anything wrong or was ineligible for Medicaid. Moreover, policymakers shouldn’t use the rates to justify imposing additional, burdensome verification and paperwork requirements that will worsen the problem of eligible people losing coverage and access to care.