Faith Advocacy Helps Take Down Indiana’s Medicaid Work Requirements

On Sept. 25^th, Indiana Governor Eric Holcomb responded to the filing of a lawsuit challenging the work requirements he imposed on residents enrolled in the Healthy Indiana Plan, his state’s version of Medicaid expansion. Just as his spokespersons had insisted for years, including to national audiences and media like the Washington Post, Holcomb boasted that the requirements were something to be proud of. Despite other states’ Medicaid work requirements being struck down by federal courts, Indiana’s were part of “the national model for successful state innovation that meets citizens' health care needs and improves lives,” he said.

Five weeks later, Holcomb ordered the requirements stopped.

Why the about-face?

Rev. David W. Greene, Sr. thinks he knows the answer. “From preachers to lawmakers to people struggling to get health care, multiple groups and people from all across different communities were speaking up, saying this was going to hurt thousands,” he says. “When you get that kind of coalition together, that’s when the powers-that-be pay attention.”

Rev. Greene is senior pastor at Second Baptist Church, known as Purpose of Life Ministries, in Indianapolis. He also chairs Concerned Clergy of Indianapolis, a pastor-led group that has been advocating for justice, particularly for the African-American community, since the early days of the civil rights movement. (Full disclosure: this writer is a member of Concerned Clergy.) Rev. Greene’s organization was one of the original coalition of Indiana groups who met with Holcomb’s team in the spring of 2018 to express face-to-face concern about the work requirements, which the Commonwealth Fund estimated could cost as many as 88,000 Hoosiers their health care.

When the governor refused to change course, the group went public with their objections. To Rev. Greene, it is important that those speaking out included both African-American urban groups like Concerned Clergy and rural-focused organizations like Hoosier Action, which is based in the southern, majority-white area of the state.

“I don’t have any doubt that the decision-makers who drafted these work requirements were targeting African Americans,” Rev. Greene says, citing the high rates of African-American unemployment and the long history of racist themes behind work mandates for social programs.

“But they were going to impact people of all ethnicities. People in poor rural areas woke up and said, ‘Hold it: This is going to be hurting me!”

Together, the groups organized in their communities, collecting thousands of signatures on a petition to the governor. Concerned Clergy reached out to congregations and media, Hoosier Action led a march to the Governor’s office and demonstration where Rev. Greene and other clergy spoke. Elected officials from the Indiana Black Legislative Caucus voiced their objections face-to-face to the governor’s staff.

“Part of a winning advocacy team is having lawmakers on the inside who have access, who can ask the right questions and say, ‘Hey, this is what my constituents are saying,” Rev. Greene says.

One of those lawmakers was State Rep. Robin Shackleford, chair of the Indiana Black Legislative Caucus. “With Pastor Greene’s leadership, the Concerned Clergy has made a phenomenal impact on the health of our community,” she says. “Their advocacy fighting against the work requirements has been a benefit to so many Hoosiers.”

That advocacy continued on for more than a year until the diverse coalition had its argument buttressed by the lawsuit filed by Indiana Legal Services and the National Health Law Program on behalf of four Indiana residents on the Medicaid program. Soon after, the governor finally abandoned his plans. The victory took on national significance, since the Trump administration’s preference for a more punitive version of Medicaid had its roots in the Indiana program created by then-governor Mike Pence and Center for Medicare and Medicaid Services administrator Seema Verma.

The work requirements struggle was not the first time Concerned Clergy had focused on health issues, nor will it be the last, Rev. Greene says. Although the organization has always engaged in community economic development and public safety issues, health is at the top of its list, too. “When you look across all the health issues that affect our lives, from breast cancer to infant mortality, there is a disproportionate impact on African Americans,” he says. “So this is always going to be a priority for us.”

For Rep. Shackleford, that is good news for the entire community. “Pastor Greene and the Concerned Clergy healthcare advocacy is an inspiring example of how congregations who lead our community daily should have a seat at the table for effective policy making,” she says.