LULU GARCIA-NAVARRO, HOST:
In the new year, Utah and Idaho will be the newest states to expand their Medicaid programs. They'll join the 35 other states who have done that under the Affordable Care Act in order to give more low-income people health coverage. Nate Hegyi from the Mountain West News Bureau reports.
NATE HEGYI, BYLINE: Conservative leaders in Idaho and Utah had been able to limit expansion efforts in those states until now.
STACY STANFORD: It's revolutionary for low-income folks.
HEGYI: Stacy Stanford is with the nonprofit advocacy group Utah Health Policy Project. She calls Medicaid expansion a once-in-a-generation opportunity to improve public health...
STANFORD: And to improve the lives of our neighbors who are just struggling to make ends meet.
HEGYI: Without expansion, Medicaid is generally unavailable to people who aren't pregnant, new parents, disabled, elderly, even if they're destitute. Utah's ballot initiative to expand Medicaid was initially scaled back by the state legislature. Republican state Senator Allen Christensen sponsored the bill to do so.
ALLEN CHRISTENSEN: To help us keep things under control and not make this a socialist-type program.
HEGYI: But the Trump administration said the Republicans' partial expansion plan would mean less federal money for the state. So state lawmakers essentially went back to what voters approved. But Christensen says there's a big exception.
CHRISTENSEN: There is a work requirement that has been approved.
HEGYI: That work requirement means nondisabled low-income folks will need to either have a job or be hunting for one to qualify for the health coverage.
Idaho's expansion also includes a work requirement. Seven other states have them. Advocates for the poor say most people on Medicaid are already working. But Ben Miller, a health policy expert at Well Being Trust, says adding work requirements can give conservative lawmakers political cover to vote for expansion.
BEN MILLER: If they can show that people are working, then ultimately, they can go back to their constituents who might be a little bit more conservative and say, look; this is not just a federal handout. We're actually making sure that they are working for the dollar.
HEGYI: Miller says work requirements add an extra administrative burden for low-income people, making it harder for them to get Medicaid coverage.
MILLER: So in some cases, we're actually penalizing people that really need coverage the most.
HEGYI: Work requirements have been blocked by the courts in Arkansas, Kentucky and New Hampshire.
For NPR News, I'm Nate Hegyi in Salt Lake City.
GARCIA-NAVARRO: That story comes to us from the Mountain West News Bureau, a public radio collaboration.
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