The Medicaid Work Requirement Is Not Just Flawed, It's Cruel

The Trump administration has just announced that it will allow states to implement work requirements for Medicaid. A majority of the United States supports requirements like these and considers them to be helpful incentives that prevent people from taking advantage of taxpayer money — but that's a deeply flawed perspective that obscures how damaging such rules can be.

Medicaid eligibility differs from state to state, but the program generally gives health coverage to people who are low-income, pregnant, disabled, or otherwise disadvantaged. It's been around since 1965 and has been expanded significantly in recent years through the Affordable Care Act. In 2015, the rates of uninsured individuals dropped by at least 10 percent in the nine states that had expanded Medicaid.

Work requirements like this are founded on the idea that low-income people are lazy and would have enough money if they just wised up and found a good job. Trump appointee Seema Verma of the Centers for Medicare and Medicaid Services talks about financial success as though it's rooted in people's mentality.

Believing that work requirements are against the purpose of Medicaid "is a tragic example of the soft bigotry of low expectations," she has said. The Trump administration says that these new requirements will help people on Medicaid. They will incentivize beneficiaries to work — the story goes — which will improve people's financial standing and health.

That's incorrect.

Verma says that the Trump administration will approve work requirements that include qualifications to cover people who are unable to work. According to The New York Times, this includes "pregnant women, elderly beneficiaries, children, or people who were unable to work because of a disability."

But first of all, not everybody with a disability has registered that disability with the government. And those aren't the only reasons why some Medicaid recipients can't work. A 2017 report from the Henry J. Kaiser Family Foundation :

35% of non-elderly Medicaid adults who are not working cite an illness or disability that prevents them from work. Others are not currently working because they are taking care of home or family (28%), in school (18%), looking for work (8%), or retired (8%).

What are people who are so sick that they can't work supposed to do? Or the people who work long hours at home every day taking care of their family members? Or students who can't work, or those who are trying to find a job but failing because of a system that's against them? It's impossible to include a list of stipulations that encompasses every possibility without leaving anyone behind.

The Kaiser Family Foundation report also provided a list of barriers that could prevent people from being able to work, which "include physical and mental health conditions, addiction, low educational attainment, limited work experience, criminal histories that impede hiring, domestic violence, and lack of affordable reliable childcare."

The New York Times notes that Medicaid has been a crucial tool for helping people who are addicted to opioids get medication and treatment and that drug addiction can prevent people from obtaining or holding down a job.

And while many think people who are on Medicaid and don't work are "lazy" and just don't want to get a job, studies have shown over and over that it isn't about that at all. The roots of poverty are institutional flaws in our education system and long legacies of racism, ableism, and other systems of oppression that stifle socioeconomic mobility. Simply telling someone to "get a job" doesn't mean that they'll be able to do so.

Not to mention, the KFF found that work requirements often have a negligible impact on increasing employment. The study looked at the Temporary Assistance for Needy Families (TANF) program, often called "welfare," and found that there was a small initial boost in employment when enrollees were subjected to a work requirement but that this boost disappeared after five years.

By then, enrollees who were not required to work were as likely — and in some cases more likely — to be employed as those who were required to work.

When we talk about health care coverage, we're talking about people's lives. No one's physical wellness should have to suffer because they aren't working. That's an unbelievably cruel argument that wealthy people, who have financial cushions to support them and don't have to worry about literally dying because they don't have enough money, never have to contemplate in personal terms.

Editor's Note: This op-ed does not reflect the views of BDG Media and is part of a larger, feminist discourse on today's political climate.