The Trump administration just released new guidance on the Medicaid program that will allow states to impose community engagement requirements, meaning a requirement to work or engage in other activities like skills training, education, job search, volunteering, or caregiving, as a prerequisite to receiving benefits.
Importantly, according to the guidance, states cannot impose these requirements on beneficiaries who are elderly, disabled, children, or pregnant women.
But such requirements for able-bodied adults are good policy: They would ensure that Medicaid is a hand up, not a handout. They would protect taxpayers and incentivize good behaviors. But perhaps most importantly, these requirements would honor the many hard-working Americans who are enrolled in the Medicaid program and already meet them. In this way, work requirements are an important way to champion the working poor.
The truth is that many Medicaid beneficiaries are already working. One study in JAMA Internal Medicine found that more than half of Medicaid beneficiaries in Michigan, where Medicaid was expanded, were working or in school.
Some opponents of work requirements (such as Sen. Bernie Sanders) are predictably calling out this new federal policy as an “attack on the poor.” (Interestingly, the four vulnerable groups his staffer mentions in this video bashing work requirementswould not be affected – Students and caregivers would presumably meet the requirement; disabled people and elderly retirees would be exempt.)
But instead, Sanders should consider who’s really under attack in today’s system: Is it fair to offer the same benefits to, for example, a hard-working, low-income single mom and a jobless, able-bodied man in his prime (who is doing nothing to search for work, improve his skill set, or care for family)?
No, it’s not, but this is the status quo in many states. The status quo is the real attack on the poor – specifically those who are poor but who are doing their darndest not to be.
Medicaid is in need of reforms that focus the program on those who need it most. The program is overcrowded today and reimburses healthcare providers too little, meaning Medicaid beneficiaries often have far inferior healthcare access and outcomes.
Community engagement requirements are a step in this direction. They will either limit the program to only those who are exempt (elderly, disabled, pregnant women, and children) or who satisfy the requirements, or they will encourage more able-bodied working-age adults to meet the requirement, or both. The latter would yield positive results for communities in the form of increased labor force participation or increased volunteering, etc., but it would also be good for those who are striving to meet the requirement. Unemployment carries with it myriad downsides; it’s associated withdepression, reduced health, and even increased rates of divorce and crime.
Finally, not only are work requirements good policy, they are actually popular policy. As the Washington Post points out, they are the most popular potential changes to the Medicaid program with the support of 70 percent of Americans. The 1990s welfare reforms under then-President Bill Clinton imposed a similar work requirement on welfare and food stamps, and those requirements were also very popular at that time.
The sad reality, thanks to the “Affordable Care Act,” is that many jobs simply don’t pay enough for workers to be able to afford health insurance coverage. But no one wants our fellow Americans to be without health coverage simply because they can’t afford it. The bigger solution to this problem is a set of health reforms that 1) lower the cost of private insurance through deregulation and 2) reform Medicaid to offer all beneficiaries greater choice in how their benefit dollars are delivered and spent.
In the meantime, work requirements are a common-sense policy that will keep Medicaid closer to its original purpose – to offer coverage as a last resort for those who are not able to obtain it on the job or afford it on their own. And critically, it sends an encouraging message to the hardworking poor who depend on the program: Their efforts and good choices are recognized and rewarded.