The White House Council of Economic Advisers has an idea to make the country healthy and happy again: Give Medicaid beneficiaries a paycheck and health care. The one condition is that they can’t have the second without the first, and in so stipulating, the Trump administration is requiring people to work to receive medical care. Welfare advocates see two problems with tying Medicaid eligibility to “work requirements”: First, there’s often a reason people who are really sick don’t work—namely, that they face major barriers to earning a decent living. Second, most of those who can work already do—and they’re likely even sicker and poorer than before because of it.
In other words, the reason they’re on Medicaid isn’t to get a job, it’s to get health care. But somehow, the Trump administration thinks the government should treat being healthy more like a reward for employment rather than a basic right—as if, unless people “earn” the right to get chemotherapy, have a healthy pregnancy, or not die of asthma, they deserve to be ill.
A federal judge, however, demonstrated a better understanding of how Medicaid works than the White House last month, by blocking Kentucky’s work “incentives” plan for Medicaid—deeming the program “arbitrary and capricious,” after it was revealed that the plan could unfairly exclude thousands of people from benefits. But the Trump administration has disregarded the court order and continued to allow states to use special waiver provisions in Medicaid to condition benefits on beneficiaries’ proving that they had worked a certain number of hours a week. The Center on Budget and Policy Priorities (CBPP) notes that a similar program pending in Arkansas is now on track to push about 7,000 people out of the system for “failing” to work enough hours.
According to the White House’s rationale, the fact that many “non-disabled” adults are on welfare is a sign that they’re just not willing to work; the simple fact that many people who are non-disabled—and therefore considered “able-bodied”—are out of work, suggests a “decline in self-sufficiency,” according to the administration. So “Expanding work requirements…would improve self-sufficiency, with little risk of substantially reversing progress in addressing material hardship.”
In overhauling Medicaid, the administration is looking to programs like the old cash-assistance program, which was “reformed” under Clinton into a welfare-to-work program as a way of pushing people back into the workforce. But CBPP says that there are often very good reasons for people to be out of work, and forcing them to take jobs now could actually lead to a long-term loss of income and health. Under sweeping reforms to the Kentucky HEALTH program, maintaining Medicaid would require 80 hours per month of “community engagement,” and benefits could be cut if they earned incomes above the poverty level or were unable to meet the work requirement.