The Trump administration wants the states to require Medicaid beneficiaries to work if they want to keep their publicly provided health insurance.
In a letter sent to all 50 states, Health Secretary Tom Price proposed a new level of flexibility and freedom in overseeing Medicaid benefits for poor, disabled, and elderly beneficiaries. But buried in the middle of the letter was a more specific suggestion of how to use that freedom.
“The best way to improve the long-term health of low-income Americans is to empower them with skills and employment,” the letter stated.
Seema Verma, who was sworn in as the new administrator for the Centers for Medicare & Medicaid Services, overseeing America’s two biggest health programs, and Price want to “review and approve meritorious innovations that build on the human dignity that comes with training, employment, and independence.”
Of course, this is a code-word for “forcing the poor and the elderly to work in order to receive Medicaid.” And states will almost certainly take them up on it. Already, there is a state waiver request pending from Kentucky requesting permission to impose work requirements as a condition of Medicaid eligibility, and Arizona and Arkansas are working on requests of their own.
A Medicaid work requirement would be a huge departure from current practice, and a move that even many conservatives disagree with. It’s also likely to be ineffective, difficult to enforce, and maybe even illegal.
“I feel some sympathy for people who are saying, ‘This is my money, I’m working, I want to make sure other people who get support are working,’” says Gail Wilensky, who ran the Centers for Medicare and Medicaid Services in the George H.W. Bush administration. “But I’m not sure when you actually look where this has been tried, it’s had much effect.”
The majority of people benefiting from Medicaid are children, disabled, or elderly. So forcing them to work would be illegal.
If you exclude pregnant women and parents with young children, the number of affected people shrinks even more. The majority of the remaining non-disabled adults are working. And some of them can only work because they get Medicaid — such as people who have mental illnesses or struggle with substance abuse but who, with reliable health care, are healthy and stable enough to work.
Making work a prerequisite for Medicaid could, perversely, wind up preventing such people from working.
“It would really harm people least able to hold and keep a job and hurt people who need health care to participate in the workforce,” Hannah Katch, a senior policy analyst at the Center on Budget and Policy Priorities and a former official in California’s Medicaid program, says.
Work requirements aren’t appropriate for the vast majority of Medicaid beneficiaries, and the program actually encourages work.
But the Trump administration is hellbent on punishing the poor while ripping off the country with weekend visits to his ar-A-Lago resort, and bankrupting the secret service to keep up his family lavish lifestyle. And did we mention his proposed tax cut for the wealthy?