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 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.
Today, the Foundation for Government Accountability released a new report, authored by myself and Jonathan Ingram. We surveyed every ObamaCare expansion state, comparing enrollment projections to actual enrollment.
Here’s what we found:
Altogether, 24 states that accepted ObamaCare’s expansion released enrollment projections in advance and have since reported at least one year of enrollment data. In total, these 24 states promised that “only” 5.5 million adults would ever sign up for ObamaCare expansion. However, actual sign-ups have surpassed these projections – and not just by a little bit. Continue reading
A new paper by Jonathan Ingram and Nic Horton examine the impact an Arkansas-style Medicaid expansion would have on Nebraska:
Nebraska legislators have taken a thoughtful approach to the Affordable Care Act, carefully reviewing the evidence and ultimately declining to expand Medicaid to a new class of able-bodied adults under the law. Nevertheless, a small group of legislators lobby their colleagues each year to expand the program. The latest proposal, offered by Senator John McCollister, would copy the expansion models used by Arkansas and Iowa, homes of the highest profile “alternative” expansion models.
Under this approach, able-bodied adults receive regular Medicaid benefits through private health insurance plans sold on the Exchange, rather than through traditional Medicaid managed care. But these expansions have been unmitigated disasters and replicating the results in Nebraska would move the state backwards.
This new approach to Medicaid expansion is unaffordable and unpredictable, pushes adults out of private insurance and into taxpayer-funded welfare, puts the truly needy on the chopping block, discourages work, and shrinks the economy. So it should be no surprise that, last year, Iowa policymakers scrapped the model entirely and Arkansas enacted legislation to repeal the expansion altogether at the end of 2016. Nebraska policymakers should learn from these mistakes, not repeat them.
Read the full paper here.
This week, the Foundation for Government Accountability published a new report on the growing food stamp crisis:
The food stamp program is one of the largest and fastest-growing welfare entitlements in the federal budget. Total enrollment reached a whopping 48 million in 2013, one of many record highs plaguing the program. Skyrocketing enrollment has led federal spending on food stamps to more than quadruple since 2000, reaching another record-high of nearly $80 billion in 2013.
One key cause of this out-of-control spending is the recent explosion of enrollment among able-bodied childless adults. Although federal law requires these adults to work in order to receive food stamps, the Obama administration has awarded an unprecedented number of waivers to states, allowing able-bodied childless adults to receive taxpayer-funded food stamp benefits without working at all.
The problem may seem purely fiscal: food stamp spending is consuming a growing portion of the federal budget, putting at risk other critical spending priorities. But the consequences of this enrollment explosion go beyond just billions of dollars. The elimination of work requirements has resulted in more people remaining trapped in government dependency for far longer than they otherwise would, has kept more people in poverty, has stymied economic growth, and has contributed to a massive expansion of the welfare state.
Reinstating work requirements for able-bodied childless adults receiving food stamps has proven profoundly successful in decreasing food stamp enrollment, returning more people to work, and even increasing volunteerism.
The way forward for states is simple and clear. Governors should just decline to renew the federal waivers that have eliminated work requirements for able-bodied childless adults on food stamps. Doing so would reduce welfare enrollment, save federal taxpayer dollars, lift more people out of poverty, increase self-sufficiency, and spur economic growth.
The full paper — authored by Jonathan Ingram and Nic Horton — can be viewed here.
Last week, the Foundation for Government Accountability released a new report on the exploding enrollment in ObamaCare expansion across the country. The report, authored by Jonathan Ingram and Nic Horton, finds that all 17 expansion states with available data were over their Year 1 enrollment projections — by an average of 91 percent. In addition, 16 of the 17 states are already over their projected maximum total enrollment, by an average of 61 percent.
From the report:
Across the country, states that opted into ObamaCare’s Medicaid expansion have seen the number of able-bodied adults on welfare skyrocket beyond expectations. In fact, after just one year of ObamaCare expansion, several states have already seen more adults sign up for Medicaid welfare than they thought would ever sign up or even be eligible.
Some politicians have cited these enrollment surges as signs of immense “success.” Taxpayers might disagree, as the economic consequences are sure to be severe. The Congressional Budget Office predicts that Medicaid expansion will discourage work and shrink the economy.1 Recent research suggests that as many as 2.6 million able-bodied adults could drop out of the labor force as a result.2 But the generational burden for future taxpayers to fund this welfare enrollment explosion is now mounting at a faster-than-expected rate, which means higher costs and even more truly needy Medicaid patients put on the chopping block.
The report was released on April 20, 2015. You can view it here.
A new report from the Foundation for Government Accountability highlights a string of broken funding promises by the federal government:
Examples of broken promises and unfunded mandates pushed on states by the federal government are virtually limitless. The Obama administration withheld $111 million in mineral royalties that had been promised to states. The Federal Highway Administration has cut back the transportation funding it had previously promised states. The Centers for Disease Control and Prevention has reduced or cancelled promised grants to state and local governments. The Department of Commerce revoked funding for a large-scale broadband project, designed to bring online access to schools and health care facilities in Louisiana. The Federal Emergency Management Agency suddenly revoked more than half a million in funds for a small Minnesota township, leaving it vulnerable to significant financial and legal liability. Stories of broken federal promises like these can be found all over the country.
The report, authored by Jonathan Ingram and Nic Horton of FGA, is available here.
FGA Action recently published two memos on bad health care proposals in two states — Arkansas and Montana.
The Arkansas memo focuses on SB828, a bill that would delegate broad policy-making authority to state bureaucrats and allow them to pursue 1332 waivers:
Senate Bill 828 gives the executive branch virtually unlimited authority with no meaningful legislative oversight. Most disturbing is the fact that some of the bill’s defenders have falsely said that the bill actually requires legislative approval. Sadly, the bill’s express language confirms this is not the case.
Senate Bill 828 provides that “any waiver submitted [by the governor] under this section shall have legislative approval” to implement those waivers.6 The bill does not say that waivers shall require legislative approval, but that they shall be deemed to have already received legislative approval.
You can read the full SB828 memo here.
On March 12, the Foundation for Government Accountability published “The ObamaCare Straightjacket: Section 1332 Waivers Are a Fool’s Errand, Not an Escape Hatch.”
The report is coauthored by FGA’s Jonathan Ingram and Nic Horton. Here’s an excerpt:
State lawmakers across the country are looking for an escape hatch from ObamaCare. A number of health care consultants have recommended Section 1332 waivers as a cure for ObamaCare’s biggest problems, promising that states will gain unprecedented flexibility to implement innovative, state-led reforms. This is a dangerous idea.
Instead of an innovative escape hatch from ObamaCare, Section 1332 waivers create a stranglehold on state-led reform initiatives. Lawmakers exploring these waivers under the false promise of “flexibility” will be disappointed. After all, Washington bureaucrats hold all the cards and they are interested in only one thing: protecting and expanding ObamaCare.
These waivers will only make ObamaCare’s impact on states worse, not better. States would be required to provide benefits at least as generous as ObamaCare, cap cost sharing at least as low as ObamaCare, and cover at least as many people as ObamaCare. Worse yet, experimenting with these waivers would put state taxpayers at risk for cost overruns for federal programs.
Section 1332 is not an escape hatch from ObamaCare. As the Obama administration itself stresses, it is a backdoor to implement even more liberal welfare policies.
To read the full paper, click here.