(This story previously appeared in The Hill Extra.)
Republicans are encouraging work requirements in exchange for Medicaid benefits but many across the political spectrum say the idea won't accomplish much.
Rep. Mark Walker (R-N.C.), chairman of the Republican Study Committee, endorsed the House GOP's ObamaCare repeal and replace plan after leadership and President Trump promised to include optional work requirements in their changes. The legislation is expected to be voted on Thursday.
Requiring work for benefits is a Republican staple, and the party points to welfare and food stamps as a model. But policy experts and advocates say the idea that poor people are freeloading and taking advantage of Medicaid, is a false characterization of the state-federal health program for the needy.
For example, Ohio recently found that its Medicaid expansion has made it easier for beneficiaries to find work. For those who were currently working, more than half of beneficiaries said that Medicaid made it easier to keep their jobs.
“There are examples of systems that can effectively move people from ‘welfare to work’ but they are not connected to work requirements,” a former Republican congressional aide who now lobbies on Medicaid issues said. “The vast majority of people getting covered have mental health, substance abuse issues. These aren’t people who aren’t working ... they’re not able bodied. It’s a lack of understanding from members and a broad generalization that these people are lazy.”
Under the proposal in the GOP bill, governors would be given the option of requiring “able-bodied adults” enrolled in Medicaid to hold a job, perform community service, or undertake training as a condition of receiving Medicaid services.
According to a House GOP aide, the requirements will be optional but there will be incentives for states that choose to adopt them. Part of the conservative argument against the Affordable Care Act’s Medicaid expansion was that it discourages “able-bodied” people from working because it provides free healthcare.
Medicaid is an entitlement, so anyone who meets eligibility rules has a right to enroll in coverage. It also means that states have guaranteed federal financial support for part of the cost of their Medicaid programs. Much of the opposition from conservatives comes from their view that preserving the expansion increases the entitlement.
“The work requirements are important. They’re something that is restorative to people’s self-worth ... sense of themselves, about working when they’re able to,” Department of Health and Human Services Secretary Tom Price said Sunday on ABC’s ‘This Week.’ “We believe it’s important for folks to have a job, that they contribute not just to society but they contribute to their own ... well-being.”
The pool of “able bodied” is relatively small, according to some data.
A blog in the journal Health Affairs cites data from the 2015 National Health Interview Survey showing that most healthy Medicaid expansion beneficiaries are working or pursuing economic opportunities. Half (48 percent) of adults covered by the Medicaid expansion are permanently disabled, have serious physical or mental limitations or are in fair or poor health.
It said just 13 percent of adult recipients of the expansion are not working, seeking work or at school.
Lawmakers say they haven’t worked out how they'll define who is an “able-bodied” adult, so they could exempt certain populations from the requirement.
Conservatives are also speaking out against the inclusion of work requirements, but for different reasons.
Robert Rector, an analyst at the Heritage Foundation, said the idea of requiring work or training in exchange for coverage is “sound in principle,” but the House proposal isn’t good policy. Rector said the requirements would be “symbolic, rather than substantial.”
“Work requirements for medical services would be almost impossible to administer and enforce. Making cash assistance or food stamps contingent on work participation is one issue, denying medical care to sick, poor people is another matter,” Rector wrote in the Heritage-sponsored publication Daily Signal.
Rector suggested Republicans impose stricter work requirements in “cash, food, and housing programs rather than the far more daunting policy of work requirements on medical care.”
See more exclusive content on policy and regulatory news on our subscription-only service here.