On Jan. 11, the Trump administration announced it would begin allowing states to force Medicaid recipients to work in order to receive the program’s benefits. Since then, 10 states have applied for the federal waivers they need in order to do so—nine of these states have Republican governors, and the one that doesn’t is North Carolina.
At first glance, this reeks of the Republican Party’s perpetual war on poor people. Upon a second or third glance, it’s still pretty clearly part of their war on poor people. But they do have some worthwhile points about the purpose and future of entitlement spending, and as important as it is to fight to protect the social safety net from conservative attacks, it’s also worthwhile to think about the original goals of welfare and to what extent they guide policy decisions today.
The Trump administration appears to be taking into account the gravity of this decision and going about implementing it in a thoughtful way. The guidelines they have set forward include a number of exemptions from the work requirement and stipulate that a number of things that are not traditionally thought of as “work” can fulfill the requirement. There are exemptions for students, pregnant women, people with disabilities, primary caregivers, and the “medically frail.” School, community service, job training, and treatment for addiction all must count as work, the guidelines say. And states are encouraged to provide job training and transportation services to help people find and keep jobs.
The problem remains, however, that a lot of people will lose coverage under these plans. The administration has approved one plan so far, in Kentucky, which estimates that 95,000 people will lose Medicaid as a result of these rule changes. Matt Bevin, Kentucky’s governor, argues that this is a good thing because those people will be more self-sufficient. While it’s true that a large portion of those 95,000 people will lose Medicaid because they get a job and make too much money to qualify, most of them will get minimum wage jobs and still be too poor to afford health insurance. Also, a lot of people will lose their coverage because they can’t find work or they can’t fill out the complicated paperwork necessary to prove they have jobs. These people will simply go from poor to poor and uninsured.
Democrats in Congress have made these points in their fervent opposition to work requirements. They have decried Republicans for their lack of compassion for low-income Americans. But while I agree that the Republican Party has shown time and time again that they have little interest in the well-being of poor people, chalking their interest in work requirements solely up to fiscal cruelty misses the legitimate ideological reasons behind their stance.
Underlying Republicans’ positions on work requirements are a few fundamental truths. First, while they often use the language of “the dignity of earning a paycheck” in disingenuous ways, it is actually good for people to work, and most people actually want to. Second, in an ideal world, everyone in the U.S. who is able would work for a living wage, and welfare rolls would be a lot smaller. Some Democrats might not concede this point when it comes to Medicaid because they see it as the basis for a future single-payer health care system, but in a broader sense, I think they would. Third, though our ballooning federal debt can be attributed primarily to military adventurism, hefty tax cuts, and Wall Street subsidies, entitlement spending makes up roughly two-thirds of the federal budget every year, a fraction that will only increase as baby boomers retire and start collecting social security checks.
Moreover, there are ideological reasons Democrats should want to get people off of welfare rolls and onto corporate paychecks. Particularly as Republicans slash corporate taxes, the federal government is increasingly funded by middle and low-income Americans, so when people get private sector jobs, it essentially forces corporate America to pick up the tab. Though it really doesn’t seem like it, there is room for bipartisan consensus on entitlement spending.
The problem is that Republicans consistently oppose minimum wage increases and have waged an all-out war on labor unions, so all the talk about “pulling yourself up by your bootstraps” that they use to oppose entitlement spending is dishonest nonsense. Until a full-time job is a ticket out of poverty, any efforts to cut people’s welfare benefits constitute nothing more than an attack on poor people.
Democrats are elected, largely, to oppose these types of attacks. But I think there is a way to do so that expresses the clear practical reasons for their opposition and a willingness to compromise and find common ideological ground, so long as it doesn’t mean sacrificing the well-being of the nation’s most vulnerable citizens.