During the first year of Trump’s tenure, conservative governors were salivating at the federal government’s doorstep, waiting for the president to grant them permission to impose work requirements on Medicaid recipients. This week, Trump finally gave them what they wanted.
In response, Democrats have forcefully come out against the move. Senator Ron Wyden called healthcare “a right that shouldn’t be contingent on the ideological agendas of politicians.” Representative Frank Pallone said the decision was a “cruel and a clear violation of both the Medicaid statute and longstanding congressional intent,” while Nancy Pelosi called it a “shameful violation of the letter and spirit of Medicaid.”
Good. Everyone deserves healthcare, and there is not a single reason why poor people should be required to prove they are working to get it. As many have pointed out, you can’t work if you’re sick and in many cases, Medicaid has been proven to help people get jobs and maintain employment. While most Medicaid beneficiaries aren’t working because they are children, elderly, or have a disability (which would exempt them from the work requirements), the majority of recipients who can work already are, in part because Medicaid helps them do so.
But the notion that poor people should work for their healthcare does not exist in a vacuum. The policy is modeled after work requirements that were imposed on cash assistance and food stamp recipients in the 1996 welfare reform bill. Which is why next time Democrats are in power, they should get rid of work requirements on all anti-poverty programs.
The argument that making people work for Medicaid is both useless and malicious can also be applied to programs like cash welfare and food stamps. Money can buy a tank of gas for someone driving to a job interview and no one can work if they’re hungry. As Dylan Matthews writes at Vox, “the case for work requirements on any means-tested government aid program is pretty weak.” Analysis by LaDonna Pavetti at the Center on Budget and Policy Priorities found that imposing work requirements on welfare recipients only drove a modest increase in recipients finding work, an effect which faded over time:
Evaluations of programs that imposed work requirements on welfare recipients found modest, statistically significant increases in employment early on among recipients subject to the requirements, but those increases faded over time. Within five years, employment among recipients not subject to work requirements was the same as or higher than employment among recipients subject to work requirements in nearly all of the programs evaluated.
What has happened instead is that the number of people living in extreme poverty in America—those living on less than $2 per person, per day—has drastically increased since the passage of welfare reform, from 636,000 households to 1.65 million households containing more than 3.5 million children.
Work requirements as a part of welfare reform, a major bill that was signed into law by then-President Bill Clinton, was a policy supported by Democrats. While Republicans are leading the push to expand work requirements to other social welfare programs today, we’re in this mess in no small part because of the way Democrats have embraced workfare over the past few decades. It’s why a policy like adding work requirements to Medicaid—which 70% of Americans support, according to a Kaiser Family Foundation poll in June—has become such an ingrained and accepted idea in this country. As one Washington Post headline put it: “Medicaid work requirements are one of the least politically controversial things Trump has done.”
Democrats need to fundamentally change the way we view government programs—not as handouts, but as human rights. Otherwise, Medicaid will only be the latest program to fall. A start, when Democrats are back in power, would be to push to banish work requirements from anti-poverty programs once and for all.