Spotlight Exclusives

Work Requirements Will Strengthen Medicaid for Society’s Most Vulnerable

Akash Chougule, Americans for Prosperity Akash Chougule, Americans for Prosperity, posted on

Can anti-poverty programs provide aid and enhance a sense of dignity and self-respect for low-income Americans?

History provides us with overwhelming evidence that the answer is yes, but a disappointing number of policymakers remain unconvinced.

A reminder was on full display following Indiana’s and Kentucky’s decision to include work requirements for certain Medicaid recipients. The proposed changes will apply only to able-bodied adults and will be subjected to months of review before they go into effect. But that has done little to deter critics from calling the move cruelpunishing, and mean-spirited.

In fact, just the opposite is true. Enacting work requirements will make it easier to care for society’s most vulnerable, while empowering low-income, able-bodied adults to pursue the dignity and self-worth that comes with work. Until recently, this thinking underpinned our anti-poverty efforts. But policymakers have been expanding eligibility and prioritizing the needs of the able-bodied over the needs of the disabled, the elderly, and expectant mothers, for whom Medicaid was intended. That leaves the most vulnerable competing with the able-bodied for Medicaid dollars.

Instead of being criticized, Indiana, Kentucky and the other states considering a work requirement for Medicaid should be commended—and emulated.

If not, rising health care costs will continue resulting in Medicaid dollars not going as far as they used to. Additionally, lower reimbursement rates for doctors will mean many enrollees – including the elderly and the disabled – will struggle to access care.

We can already see this in places like Arkansas, where the Medicaid waiver wait list for individuals with developmental disabilities has grown by 700, and 79 disabled Arkansans died awaiting care since Medicaid’s most recent expansion in 2014. And in Illinois, a total of 752 individuals perished on waiting lists after Medicaid expansion increased enrollment numbers to include the able-bodied.

Nationally, one estimate pegs the number of able-bodied adults on Medicaid at close to 12.7 million. And according to two state-estimates, those numbers may be closer to 130,000 in Indiana and 175,000 in Kentucky.

And even for the able-bodied adults who will be subjected to the proposed work requirements, work is defined loosely. Every state will come up with their own definition, but among the provisions being discussed that would constitute “work” for the able-bodied are job training programs, school, or substance abuse treatment.

Critics seem to think that work requirements are some kind of punishment. Nothing could be further from the truth. Arthur Brooks, president of the American Enterprise Institute, describes it as bridging the dignity deficit. The trillions of dollars devoted across nearly half a century to the War on Poverty, Brooks argues, were largely spent on a failed exercise because the policies did next to nothing to help recipients feel needed or regain a sense of dignity and self-worth. Instead, he writes, the federal government has basically concluded that low-income Americans are little more than a liability to manage.

That worldview saps the untapped potential found in every able-bodied adult. And it ignores the reality that government is often out of its depth in confronting such challenges.

This is precisely what Carla Javits, the president of the California-based venture-philanthropy fund REDF, which works directly with the formerly incarcerated, the homeless and at risk-youth trying to enter the workforce has found.

In an interview with the Philanthropy Roundtable, Javits recounts:

“When you ask the people we’re helping why they are so excited to have a job, you’d think the first thing they would say is the paycheck—because we’re talking about people who are extremely low-income. Yet they almost never give that as their first answer. It’s almost always dignity, self-respect, participation, team, and community.”

Done right, Medicaid work requirements will go a long way toward protecting society’s most vulnerable, while also affirming work—and the dignity that comes with it.

Akash Chougule is the director of policy at Americans for Prosperity


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