For many, the New Year begins with a resolution to get healthy by working out. This year, the government resolves to force millions of Americans to commit to a new fitness goal: Start working, or you can’t have health care.
Such is the logic behind the so-called “work requirements” the Trump administration has presented as reform for Medicaid, the federal means-tested health-care system for the lowest-income Americans. Under the planned new Health and Human Services regulations announced last week, waivers will be granted to states willing to restructure their programs to force individuals who would otherwise be eligible for Medicaid to work—generally for about 20 hours a week—to qualify for coverage. So far 10 states have applied for the planned waivers: Arizona, Arkansas, Indiana, Kansas, Kentucky, New Hampshire, North Carolina, Maine, Utah, and Wisconsin. Most of the states recently expanded Medicaid eligibility standards under the Affordable Care Act, so those who newly gained coverage will be especially hard-hit. The plan purports to help the poor economically and health-wise, but its almost certain to make people poorer and sicker instead. Nationwide, the changes are expected to drastically reduce enrollment, arbitrarily denying millions of impoverished people access to life-saving medical services.
Anti-poverty and health-care advocates say the waivers, which enable state Medicaid programs to mandate employment for all so-called “able-bodied” adults, are not only cruel but irrational: The vast majority of working-age Medicaid recipients (excluding the elderly and people with disabilities) currently are already employed anyway. Those who aren’t are often facing severe employment barriers precisely because of poor health. According to the think tank CLASP, “over one-third of working-age Medicaid recipients not working are unemployed because of illness or disability.”
Making the poor work for health care may seem absurd, but it actually reflects a core idea of the conservative agenda to shrink the welfare state. Although historically, Medicaid was designed as a social protection for the most vulnerable, the new rules undermine the moral premise of the system by imposing a price on the right to health. Echoing the work mandates imposed under Clinton-era “welfare reform,” linking employment to means-tested federal benefits is a proven way to both reduce enrollment and further entrench poverty. Since those reforms of the late 1990s, hundreds of thousands of working families have been shoved off the welfare rolls, yet remain trapped in dire poverty.