The fate of Obamacare, and with it Medicaid, is one of those Washington issues that will affect Maryland.

States could get less money but more freedom in running their Medicaid programs if the Congress decides to block grant the program.

That’s what happened under federal welfare reform.

Since Fiscal Year 2011, Maryland’s program has run a deficit. The ending balance over the last four years has averaged minus $15 million.

Several Republican governors are devising proposals that would require many Medicaid recipients to have a job, participate in job training, or perform community service, according to the New York Times.

When we adopted a drug testing requirement as part of Maryland’s welfare reform, I asked Peter Beilenson, then the Baltimore City Health Commissioner, for his advice.

I did so again this week.

Peter responded: “I’ve come to the conclusion that work requirements for vital social service programs are, most of the time, short-sighted, particularly with medical services. Imposing work requirements for Medicaid will push many so-called able-bodied individuals off the Medicaid rolls due to inability to find jobs (mentally ill, substance users, under-qualified for any livable wage jobs, etc) and these people who lose Medicaid coverage will cost far more due to uncompensated care for untreated chronic conditions than if they had stayed on Medicaid.”