A Thought on Medicaid Work Requirements

Medicaid was created in the mid-1960s, mostly to help pregnant women, single mothers with children, and people who had lost their jobs and, along with it, their health insurance. The program has grown tremendously over the past 50+ years but its focus is still mostly on very low-income people who have no insurance.

The Trump administration recently announced that it will permit states to impose work requirements on Medicaid recipients.

Actually, The Curmudgeon needs to digress for a moment here: they aren’t exactly calling it a work requirement. No, they have another term for work: community engagement.

Seriously: they’re referring to work as “community engagement.”

As in

Hi, honey, I’m home.

Hi, sweetheart. How was community engagement today?

On the surface this doesn’t sound like such a terrible idea. After all, if the taxpayers are giving something of value to people, isn’t getting a job the least those people can do in return?

If only it were that simple.

Together, the federal government and the states spend about $566 billion a year on Medicaid for about 68 million people.


People in nursing homes or receiving services in the home to keep them out of nursing homes account for seven percent of all Medicaid recipients – but for 30 percent of all Medicaid spending. Actually, many of these people are middle-class, but you never hear anyone talk about taking Medicaid-covered nursing home services away from middle-class people – probably because middle-class people vote. Presumably, the federal government doesn’t expect grandma to go out and get a job. She may get around reasonably well on her walker but not that well. So we know the work requirement isn’t just about saving money because if you’re serious about cutting Medicaid spending, this is where the money is.

Fourteen percent of Medicaid recipients are disabled. Some of them might be able to work but most probably can’t.

Forty-three percent of Medicaid recipients are children. Do we really expect Billy to miss recess so he can punch a clock?

The rest are adults. Some of them are pregnant women, some of whom can work and some who cannot.

The rest of the rest are able-bodied adults and they’re the real target of this new policy, but therein lies the rub: it turns out that 60 percent of working age, non-disabled Medicaid recipients already have jobs and 80 percent of Medicaid recipients live in families in which at least one person already has a job. Their problem: they work for companies that don’t offer health insurance and they can’t afford it on their own because they’re generally only making enough to pay the rent and put food on the table.

So who are the Trumpets targeting with this new interest in penalizing Medicaid recipients who don’t have jobs?

Well, there are those who are on Medicaid because… well, because they just lost their jobs, which is one of the reasons the program was created in the first place and is referred to as a social safety-net program. These folks didn’t just decide not to work anymore: most either were laid off or fired. Most are already probably looking for work.

Which means they’re suggesting that it’s perfectly acceptable to deny coverage to people who just lost their jobs because…because they don’t have jobs.

Which makes a whole lot of sense, right?

So then who is really being targeted by these work requirements?

Really? White working-class people who voted for Trump: this is his signal to them that he’s not going to let people who don’t look like they’re from Norway, his new second-favorite country, ride the gravy train while they work hard for a living. This is pure politics and mostly racial politics and it’s typical of this administration.

And it’s deplorable.

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