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Karen Fratti
January 12, 2018 2:22 pm

In order to help states do more with less money, on Thursday the Trump administration sent guidelines to states that would allow them to impose work requirements on people who get Medicaid, the health care program that’s jointly funded by federal and state governments for low income and disabled people. Each state runs its own Medicaid program and there are ten states considering instituting the work requirement, meaning that someone would have to prove that they have a job, or at least are in school, are a caregiver, volunteer, or participate in other approved “community engagement,” according to the Washington Post. Elderly, disabled, pregnant people, along with kids, would be excluded.

The problem? Most people on Medicaid already work, which means the administration obviously hasn’t done its homework on the matter. It would also eliminate people who are currently eligible but can’t work.

The head of the Center for Medicare & Medical Services, Seema Verma, issued the guidelines on Thursday and then tweeted that the new guidelines would “improve Medicaid enrollee health outcomes by incentivizing community engagement.” She said in a call with reporters on Thursday, according to WNYC, that this “is about helping people rise out of poverty.” However, studies show that access to essential health care actually helps people hold down a job, whereas not having health care makes it harder for people to keep a job. Research mostly shows that most Medicaid recipients, much like people who use food benefits or “welfare,” which is a pretty imprecise term, already work. So why is the move so popular among lawmakers?

Arizona, Arkansas, Indiana, Kansas, Kentucky, Maine, New Hampshire, North Carolina, Utah, and Wisconsin have already filed applications to impose work requirements on its residents. Since so many people with Medicaid already work, and there could be exemptions, for example, for people with substance abuse issues who are in rehab to be considered involved in “community engagement,” it’s not clear how many people would be affected. But it is a clear sign that lawmakers are very interested in purging the rolls, so to speak, of people who are getting essential health care benefits through Medicaid in the name of trimming federal and state budgets. They also have some pretense that people who receive health care benefits from the government will all of a sudden be lifted out of poverty with one part-time job or volunteer work.

Kansas and Maine both boasted great success after imposing work requirements for SNAP (Supplemental Nutrition Assistance Program) beneficiaries. In Kansas, around 13,000 people stopped getting benefits, according to one study. But just like with health care, a lot of people who receive benefits already work, and the states didn’t account for the fact that people don’t usually get food benefits forever. Basically, a large percentage of that 13,000 people might have gone off the benefits program anyway.

According to the Washington Post, about 80 percent of Republicans and a majority of Democrats favor work benefits, while those that oppose it believe that health care and food are rights that all Americans should enjoy. The idea that work should be tied to “welfare” is a very American one, that favors “personal responsibility.” It became really popular under President Bill Clinton when he used it to overhaul the Arkansas Medicaid program and then applied it to federal programs.

But a lot of people get left behind when you impose work requirements. Not everyone who needs and receives assistance is fundamentally “lazy.”

Our benefits system needs to be reformed, for sure, but not by disqualifying people based on some false assumption that everyone can work, or that work pays all the bills, or that poverty isn’t a lot more complex than just “not having a job.” 

The New York Times tells the the story of a 38-year-old man in Arkansas who was kicked off of SNAP because of work requirements. He works as a part-time security guard after a long recovery from a surgery that removed a tumor in his spine. He has Medicaid, but lost SNAP benefits because he wasn’t able to work the required 20 hours a week. The man, who earns $10 an hour as a security guard, told the newspaper, “I went from being able to eat vegetables to eating Hamburger Helper every day. I think most people want to work, but I also know a lot of people work when it’s not necessarily in their health’s best interest.”

It’s also just not easy for everyone to find work, and it has nothing to do with wanting a job or wanting to be stuck in a cycle of poverty. Mandy Davis, a social worker at the Jericho Way homeless shelter in Arkansas, noted in the New York Times, “Low-income people often face numerous roadblocks in finding work. Some have criminal records. Others lack a cellphone or reliable transportation. Middle-class America believes in work because we do it ourselves. But we have resources, an education, transportation, a supportive family.”

It’s very easy to scoff about “getting a job,” but it is easier for so many more people — even single, able-bodied people that the new requirements are supposed to help — than others to even get part-time employment that would help them meet some of the proposed requirements. Again, this is health care we’re talking about, so running an experiment about what happens when you make people work for benefits isn’t low stakes at all. It could be life or death for some people. If anything, it sends a message that if you can’t work, you don’t deserve help, which is a really warped message to send into the world.

Once again, the Trump administration has rolled back another protection that the Obama administration had defended without, apparently, really considering the current research or consequences. It’s discouraging that lawmakers on both sides seem to agree that expanded tax benefits for wealthy people are more important than expanded budgets for helping poor people and people in poverty live their best lives, too. What would happen if we actually started to give to the most needy instead of taking things away from them?

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