With new work requirements, health care coverage for Oklahomans without internet access is at risk

Aaron Krusniak is an OK Policy intern and a third-year Computer Science major at the University of Tulsa with a focus in cybersecurity and smart urban planning.

Between recently passed legislation and an Executive Order, Oklahoma is moving quickly to enact a policy allowing the state to kick low-income parents off their SoonerCare coverage if they fail to work for enough hours in a given week. Oklahoma officials must now develop a specific proposal to implement this idea and ask for approval from the federal government.

If the proposed work requirement takes effect, thousands of parents would be required to either work, volunteer, or participate in some form of job search or training activities for 20 hours each week in order to keep their health care. Recipients would also have to report these hours to the Oklahoma Health Care Authority, most likely by uploading a timecard, pay stub, job application, or other paperwork to the OHCA’s website.

We’ve pointed out the many, many issues with a work requirement before. A work requirement can actually harm people who are working, because many low-wage workers don’t have control over their hours or scheduling and frequently work in jobs with significant seasonal variation. For example, workers in food services, retail, and construction all report significantly fluctuating weekly hours, often due to being scheduled for shifts as needed on a weekly basis, being held “on call,” (where workers are expected to be available at any time but in reality work few weekly hours), or even just because of poor weather conditions.

However, work requirements also rely on another factor workers may not have much control over: the capability to upload their work information online, which is impossible without some form of internet access. Unfortunately, a lack of reliable internet access is a reality for a startling number of Oklahomans— especially those with low incomes who are eligible for programs like Medicaid. Overall, about 1 in 3 Oklahoma households do not have a broadband internet subscription. And without readily-available Internet access to report their work activity, parents on SoonerCare could be at risk of losing their coverage as a result.

Internet access rates are lower among key groups who rely on SoonerCare.

We frequently take the internet for granted as a service that nearly everyone can use, but there are still large groups of Americans who aren’t able to surf the web. Low-income Americans are among the least likely to to have access to the internet. Only about half of households making less than $30,000 annually had home broadband in 2016, according to the Pew Research Center. And in Oklahoma, those low-income households often need SoonerCare for their basic health coverage.

These statistics reveal a hidden reality: internet access isn’t as widespread as we’d like to think it is, particularly for the poorer and/or aging individuals who have the greatest need for SoonerCare. Access rates could be even lower for those living in Oklahoma’s rural and tribal areas: just under two-thirds of rural homes, and only one-third of tribal homes had broadband internet access in 2016, according to the FCC.

For many of these Oklahomans, access to the internet isn’t just unavailable— it may be nearly unattainable. Consider, for example, those who live in rural communities where broadband services aren’t always available, much less affordable. The next best alternative might then be to drive somewhere with an internet connection, perhaps to the nearest town with a public library. But this drive could be lengthy, and would have to be made frequently— assuming one has easy access to a car, additional gas, and perhaps time off from work or caregiving to make the drive. For many who depend on SoonerCare, that just isn’t a realistic possibility.

Households without broadband frequently rely on internet-equipped smartphones for internet access. But again, data shows that low-income and older individuals are less likely to have phones capable of photographing and uploading information. Mobile internet access rates, while higher than access to traditional broadband, follow many of the same patterns. About one-third of people who make less than $30,000 annually and one-third of people who live in rural areas don’t have a smartphone. While mobile internet access is steadily improving across the board each year, it’s still nowhere close to ensuring widespread coverage for the groups who would need it most under the new work requirements plan.

Without internet access, SoonerCare recipients are in jeopardy of losing their coverage.

The exact ways in which the work requirements program would function are still up in the air. However, if Oklahoma’s plan is similar to other states that have passed work requirements, then lack of internet access could seriously threaten those who rely on SoonerCare. Indiana, Kentucky, and Arkansas have all passed Medicaid work requirements legislation this year that instituted “lock-out” periods for those that aren’t able to prove that they’re working. In Arkansas, individuals who fail to to demonstrate they’re meeting work requirements are cut off from coverage for the rest of the calendar year – and only allowed to re-enroll if they can prove they’re meeting the requirement. Arkansas also requires its members to log their hours within just a few days of the previous month, giving members with no or limited internet a very narrow window to demonstrate compliance. If Oklahoma follows down this path, hardworking Oklahomans who rely on SoonerCare could be denied coverage, potentially for months— just because they can’t submit the proof that they’re working enough.

Clearly, Oklahoma’s proposed work requirements fail to recognize the real needs and abilities of people who rely on SoonerCare for their health coverage. As Oklahoma develops a plan for restricting SoonerCare benefits and the federal government weighs whether it should be approved, they should take into account the very real difficulties any such restriction would impose on Oklahoma families.