On Jan. 11, the Trump administration’s Centers for Medicare and Medicaid Services (CMS) issued a new guidance to state Medicaid directors permitting them to create work/community engagement requirements for able-bodied Medicaid recipients. Federal officials have never previously allowed states to enact work requirements for Medicaid, a program intended to act as a health insurance safety net for the neediest Americans.
Work requirements are an essential tool all states should utilize. They have been proven to help impoverished families move from dependency to self-sufficiency and guarantee Medicaid programs have enough money to cover the costs of those children, disabled, and sick Americans who desperately need access to health insurance but don’t have the ability to pay for it themselves.
{mosads}Unfortunately, many liberal pundits and Democrats are using the Trump administration’s common-sense policy enhancement as an opportunity to spread numerous myths about Medicaid reform and hurl completely false allegations about those who want to implement improvements to welfare programs. Below are some of those myths, along with the truth about work requirements and their tremendous value.
Myth one: Work requirements are unfair because some people can’t find jobs.
The term “work requirements” is a bit misleading. Generally, safety-net “work requirements” allow recipients to participate in “community engagement activities” instead of obtaining a traditional job. These activities include volunteering, joining a job-training program, and enrolling in college or another qualifying education program.
Myth two: Work requirements hurt the poor.
On Jan. 12, New York Times columnist Paul Krugman wrote that the reason reformers want to change welfare programs such as Medicaid is because they want to cause “pain.”
“Over the past few years it has become increasingly clear that the suffering imposed by Republican opposition to safety-net programs isn’t a bug, it’s a feature. Inflicting pain is the point,” Krugman wrote.
This is completely untrue. The Trump administration and states desiring to pass Medicaid reform know that without work requirements and other reforms that incentivize people who can work to pursue self-sufficiency, many people who don’t have job skills end up trapped in a cycle of poverty and others abuse the system, consuming resources meant only for the neediest Americans.
Although Medicaid work requirements have never been allowed until now, work requirements in other safety-net programs have helped millions of people become less dependent on the government. Prior to welfare reform being implemented in 1996 by a Republican-led Congress and President Clinton, there were 13.4 million (1995 figure) Americans enrolled in the nation’s Aid to Families with Dependent Children program. Since then, rolls in that program — now called Temporary Assistance for Needy Families (TANF) program — have declined by 73 percent, down to about 3.7 million people.
Similarly, welfare reforms passed in Kansas improved families’ financial well-being to an astounding degree. Nic Horton and Jonathan Ingram at the Foundation for Government Accountability (FGA) found those who left TANF in Kansas experienced an income increase of 104 percent after just one year off the program and 247 percent after four years.
In allowing work requirements for Medicaid, the Trump administration isn’t trying to “inflict harm,” it’s trying to help able-bodied people on Medicaid experience the same kind of positive results many people once dependent on TANF now enjoy.
Myth three: Work requirements are cruel and target the disabled and stay-at-home parents.
Perhaps one of the most widespread myths circulating about work requirements is that they somehow force extremely sick and disabled people to work. It’s strange that this myth has garnered so much attention since the CMS guidance specifically states the work requirements may only apply to “non-elderly, non-pregnant adult Medicaid beneficiaries who are eligible for Medicaid on a basis other than disability.” In other words, states cannot force those who are disabled to work.
Some have argued that there are many people who depend on Medicaid with serious illnesses that don’t qualify as “disabilities.” I’m not sure how many of these individuals exist, but nothing is forcing states to make these people work, and CMS has the power to reject any proposed Medicaid waiver that cruelly targets any group of Americans.
Others have claimed work requirements hurt families because they force adults caring for loved ones full-time to spend too much time away from home. However, the CMS guidance lists “caregiving” as one of the activities that can satisfy a state’s work or community engagement requirements, so there’s no reason to think millions of kids in Medicaid households will suddenly be abandoned by mom or dad when a state passes Medicaid work requirement legislation.
Myth four: Work requirements make people “jump through hoops to prove their neediness.”
In Krugman’s article for the Times, he argued Medicaid work requirements aren’t “about saving money,” but rather “stigmatizing those who receive government aid, forcing them to jump through hoops to prove their neediness.”
This, too, is all wrong. Work requirements don’t have anything to do with making people “prove their neediness,” although recipients are, of course, required under various other provisions to prove they are qualified before they receive Medicaid. Work requirements simply ask those who receive taxpayer-funded Medicaid insurance to do their fair share, by working, volunteering, or educating themselves so that they can eventually afford to pay for their own private health insurance.
There are other Medicaid reforms states have (and should) pass that deal with asset testing and other methods for ensuring those who enroll in Medicaid really need it, but work requirements are totally separate.
Myth five: Work requirements won’t save any money and are unpopular.
The Foundation for Government Accountability projects nationwide Medicaid work requirements would lower enrollment by 13.6 million by 2027 and save $1 trillion over ten years. Even if FGA is way off, work requirements are still likely to save hundreds of billions of dollars and help millions of people become less dependent on government.
Further, despite all the negative press they have received, polling shows Medicaid work requirements are popular. According to Rasmussen Reports, which conducted a national telephone and online survey of 1,000 Americans on Jan. 14–15, “64 percent of American Adults think that childless, able-bodied adults in their state should be required to work as a condition for receiving Medicaid. Just 22 percent disagree, while 14 percent are not sure.”
Justin Haskins (@JustinTHaskins) is executive editor and a research fellow at The Heartland Institute, an Illinois-based nonprofit group that advocates for limited government.