Medicaid is out of control and unsustainable. Work requirements could help.
It’s not the lead story on the nightly news, and it’s not generating millions of clicks online. It may be one of the most underreported, underappreciated public-policy crises of our time. That’s a terrifying reality because, left unaddressed, this crisis will come at great cost to America’s most vulnerable.
The Medicaid program is at its breaking point. Even before Obamacare lured some states into expanding the program to non-disabled, working-age adults, Medicaid was growing at an alarming rate. Now, in the Obamacare era, the program is growing even faster, siphoning more and more resources away from folks who truly depend on Medicaid for survival.
A new report, released this week by the Foundation for Government Accountability, gives a glimpse of just how serious the problem is.
The state of Maine has long been on the leading edge of welfare reform. Under Governor Paul LePage, it has reformed its food-stamp program by promoting work, resulting in former enrollees’ more than doubling their incomes the following year. Maine has also worked tirelessly to find and prosecute welfare fraud, going after those who steal limited resources from the people who most need help.
These efforts, combined with Maine’s rejection of Obamacare’s Medicaid expansion, have allowed the state to make the truly needy a priority. But Maine’s not slowing down. Continue reading
Exploding welfare enrollment is one of the largest challenges facing states today. Since 2000, the number of people dependent on Medicaid has more than doubled and the number of able-bodied adults on the program has nearly quadrupled. As a result, total Medicaid spending has skyrocketed, almost tripling from $206 billion in 2000 to nearly $600 billion today.
Even worse, Medicaid spending is now consuming nearly a third of state budgets, leaving fewer and fewer dollars to spend on education, infrastructure, and law enforcement. It’s clear that the current path is unsustainable; states need options to rein in spending, relieve taxpayers, and reserve resources for the truly needy. And the answer is work.
In 2011, Kansas Governor Sam Brownback instituted new sanctions in his state’s cash assistance program for able-bodied adults who refused to meet work requirements. But the Brownback administration didn’t just implement the reform and move on — they tracked the impact so they could see what happened to these individuals once they left welfare. Three key results should inspire policymakers in other states and in Washington D.C. to expand work requirements to able-bodied adults in as many programs as possible. Continue reading
Work requirements are a critical part of welfare. Without them in place, welfare can quickly become a way of life instead of a temporary safety net. Unfortunately, states have used numerous workarounds to void work requirements in food stamps, perpetuating dependency and leaving taxpayers on the hook.
One such workaround is blanket waivers. States can get permission from the federal government to exempt able-bodied, childless adults from work requirements if they qualify for work waivers. Under federal law, states must have at least 10 percent unemployment or “a demonstrated lack of job opportunities” to qualify for these waivers, but agency interpretation of these rules has expanded them well beyond their original intent.
In 2015, 42 states were using these waivers to waive work requirements entirely. Thankfully, that trend is starting to reverse and states that are now enforcing work have seen the incomes of former enrollees more than double, more than offsetting lost welfare benefits and leaving them better off overall.
But even if states no longer qualify for blanket waivers, there’s another workaround they can use to skirt work requirements. It’s called the 15 percent exemption. Continue reading
Most people agree on what seems to be a pretty basic fact: the same dollar cannot be spent twice. Money is finite. And when government spends a dollar – or several billion – giving welfare to people who shouldn’t receive it, logic follows that those dollars cannot then be spent on something else. Pretty simple, right?
Well, apparently not for everyone.
In his recent remarks to the National Governor’s Association, Vice President Mike Pence drove home this simple truth – that resources are limited and, as a consequence of that reality, ObamaCare’s Medicaid expansion has put “far too many able-bodied adults on the Medicaid rolls, leaving many disabled and vulnerable Americans at the back of the line.” The left proceeded to have a meltdown.
The problem for them – and for all of us – is that Pence was right. Continue reading
The Heritage Foundation recently published their annual index on culture and opportunity. I was fortunate enough to author a chapter for them on welfare policy.
Here is an excerpt:
Unlike pre-reform recipients, individuals who enroll in the TANF program today know that their time is limited. They know, in most cases, that they are expected to work and that dependence on cash assistance is not a lifestyle they can maintain over the long term. This is good news for their well-being, because research has shown that the less time individuals spend on welfare, the quicker they will go back to work. And when they do, their incomes will more than double on average, more than offsetting lost welfare benefits and leaving them better off than they were before.
You can read the full piece here.
Arkansas made national headlines in 2013 when then-governor Mike Beebe, a Democrat, struck a deal to make Arkansas the first southern state to expand Medicaid through Obamacare. Shortly thereafter, Beebe exited (stage left), leaving a fiscal, political, and moral disaster for the new administration to grapple with. But now, thanks in large part to the leadership of Republican governor Asa Hutchinson, Arkansas is taking significant steps toward reversing Obamacare’s devastating impact. Other expansion states should take note. Continue reading
“We will get our people off of welfare and back to work,” President Trump said in his inaugural address. He continued that theme the next month at CPAC, the Conservative Political Action Conference. “It’s time for all Americans to get off of welfare and get back to work,” he told the crowd. “You’re going to love it, you’re going to love it, you’re going to love it.” And in his address to a joint session of Congress a few days later, the president boldly declared that “millions lifted from welfare to work is not too much to expect.”
This was music to the ears of hard-working Americans across the country, after eight long years of welfare expansion and increased dependency. But how can President Trump deliver on these promises? Continue reading
One of the most significant yet underreported outcomes of ObamaCare is its impact on the truly needy. Before ObamaCare, our country maintained a safety net that was reserved for our neediest neighbors. The Medicaid program, for example, primarily served poor children, seniors, and individuals with disabilities.
But ObamaCare’s Medicaid expansion sought to change this. It sought to transform a safety net into an open-ended, free-for-all welfare program for non-disabled, working-age adults, the overwhelming majority of whom have no dependent children at home. Every penny spent on this new population is a penny that can’t be spent on the truly vulnerable. That’s just a fact.
Many of these individuals – nearly 600,000 nationwide – currently sit on Medicaid waiting lists, hoping to get additional services that states say they need but, due to limited funding, states can’t afford. Literally, states have said, “You need this service but we do not have the adequate funding to provide it for you.” As a result, these individuals sit and wait. Many of them will die before they ever get the care they need.
Some might call that rationing. At best, it is misprioritization. Continue reading