Adding work needs to Medicaid isn't a bad idea
Over the past 46 years that I've been part of America's job training system, work requirements for government benefits have been proposed several times. Each time these work rules have been initially denounced by opponents as 'cruel,' 'punitive,' 'blaming the victim' — with accompanying fears that benefit recipients were not ready to be employed and would lose needed benefits. Yet each time work requirements have been implemented, they have resulted in increased employment and other life benefits for a significant segment of participants, their families and local communities. Those are the metrics by which to measure success; reducing the rolls of benefit programs has not been the main goal sought by advocates of previous work requirements. The results have been documented over the years by scholars representing a range of viewpoints: Harry Holzer of Georgetown, Lawrence Mead of New York University and the professional research staff at MDRC, to cite a few. These results have been seen with work rules imposed for welfare recipients, recipients of various General Assistance benefits and parents who owe child support. They will be seen again if the proposed Medicaid work rules go forward and are implemented seriously and with purpose.
Individuals on welfare and other benefit programs often need a push into the job world. They may lack confidence, have become discouraged or have no idea how to get started. Work rules provide that push. They also provide a support network for job placement and retention. America Works is one of the nation's largest job agencies serving unemployed people, referred by various government benefit programs. Each participant is assigned a job counselor and develops an individual employment plan. The counselor is to identify job openings, assist the participant in applying, advocate for the participant to employers. The counselor is also trained to be the coach whom all job seekers need: keeping spirits up through the (likely many) rejections, serving as a problem solver during the placement process and troubleshooting when job issues inevitably arise after placement. At each stage, the participant is no longer on their own.
Since the early 1980s, work rules have been most extensively tested, studied and monitored in the welfare system, first as pilot projects by individual states and later under the federal welfare reform of 1996. Welfare scholars of the 1980s, including Manpower Demonstration Research Corp. President Judith Gueron would highlight how much previous welfare policies divorced from work requirements had underestimated the work orientation and strengths of welfare recipients. Researchers of welfare-to-work programs of the 1990s and early 2000s at the Urban Institute and with a consortium of university centers would confirm the widespread work orientation of welfare recipients, as well as their abilities to function in the work world. This is not to romanticize welfare-to-work. Despite the counseling and supports (transportation subsidies, child-care subsidies), a good number of participants drop out during the placement process or within a year of job placement. They do so because of chaotic personal lives or mental illnesses or developmental disabilities that the job placement system is unable to address. They do so because of an absence of a family network, or because they don't want to risk the other housing, healthcare and food stamp benefits they receive beyond the welfare payment. Even those who obtain jobs often struggle economically.
At the same time, for those who are able to maintain a job, the job frequently brings values beyond the income. Jason Turner, the architect of the early Wisconsin welfare-to-work successes and later commissioner of New York City's Human Resources Administration, references the power of the job, drawing on his experiences over four decades. A job brings structure to participants in work requirement programs, somewhere to go every day. It brings a new confidence, which can translate into addressing daily life responsibilities that previously seemed overwhelming. In theory, the importance of employment is hailed across the political spectrum. In practice, though, the ties of government benefits to employment have been weakened in the past two decades — and so many opportunities to demonstrate the value of this connection have been missed. Welfare-to-work requirements have been diluted in major cities and blue states. Employment efforts for recipients of Supplemental Security Income and Social Security Disability Insurance have stalled. Guaranteed incomes schemes removed from employment have gained currency.
Hashtags
Try Our AI Features
Explore what Daily8 AI can do for you:
Comments
No comments yet...
Related Articles
Gulf Today
2 days ago
- Gulf Today
The Republican Party's fiscal hawk era is officially over
There is no constituency for debt reduction, which is a fancy way of saying voters don't care that the federal balance sheet is roughly $37 trillion in the red — and growing. This simple fact of American politics goes a long way toward explaining why President Donald Trump, with the help of congressional Republicans, is pushing a sweeping reconciliation package of tax cuts and fresh domestic spending priorities that is projected to add approximately $3.8 trillion to the swelling federal debt. Politics is a service business and Trump and his Capitol Hill allies are aiming to please the customer. So they've loaded up the reconciliation package, dubbed the One Big Beautiful Bill Act, with a series of crowd-pleasers — expansions of existing tax breaks plus some brand-new ones. Yes, there are spending cuts. The version of the legislation that passed in the House of Representatives and is now up for consideration in the Senate includes reductions to Medicaid and other budget line items. But there's nothing in the bill that results in a net decrease in the debt. Even the proposed changes to Medicaid face an uncertain future, thanks to GOP opposition in the Senate. That's because the sort of substantial spending cuts and programme reforms required to break Washington's addiction to borrowing would be wildly unpopular. For instance, any meaningful attempt to balance the books probably requires both raising taxes and overhauling Medicare and Social Security. That's not a recipe for winning elections. As concerning as the US debt load is becoming for bond markets and some finance titans (and the few fiscal hawks left in Washington), most Americans have more urgent concerns, said David Winston, a Republican pollster who has been surveying voters for more than 25 years. 'There's another issue hitting voters that's a bigger deal, and that's inflation,' he told me. 'When you're looking at an economic situation where there's something that's pressing people at a personal level, it's not that the deficit isn't important, it is. But being able to pay bills and deal with things on a weekly basis and keep up with all your costs takes precedence.' Winston is right — and that's not to mention the fact that so many voters are convinced the looming debt bomb can be diffused by eliminating waste, fraud and abuse in government spending. But this isn't a new phenomenon. Voters generally, particularly on the left, have always found some reason or another for opposing legislation that asks them to participate in the solution to Washington's fiscal challenges. It's why tax hikes on the so-called rich are so popular and such an easy political message to wield. What has changed is the Republican Party and the voters it represents. Without question, Republican presidents prior to Trump were complicit in running up the debt. But in the pre-Trump era defined by President Ronald Reagan, fiscal responsibility and small government had currency with grassroots conservatives who formed the heart of the GOP base. But today's Republican base voters are different than their forebearers, courtesy of a Trump populist makeover. The 45th and 47th president over the past decade attracted legions of working-class voters to the Republican Party. For the most part, these newer Republicans are former Democrats who joined the GOP for cultural reasons; for instance, they passionately oppose abortion rights and support gun rights. Notably, they brought with them their preference for government safety-net programs and general lack of concern about the debt (qualities that have long defined grassroots Democrats). Simultaneously, suburban voters inclined to value fiscal responsibility generally, and debt reduction specifically, have drifted away from the GOP. The result is a Republican governing coalition much more enamored of government spending than it used to be and far less concerned about the federal debt, even though it has grown to more than 120% of the entire US economy — problematic to say the least. Brad Todd, a veteran Republican strategist in Washington and coauthor of The Great Revolt; Inside the Populist Coalition Reshaping American Politics, has closely monitored this electoral transformation. 'The voters who are additive to the coalition as a result of Donald Trump are voters who are not only comfortable with entitlements. They're wary of anybody that might cut them. One of the reasons these voters were not Republican for a long time is because they believed the Democrats' scare tactics on entitlements,' Todd told me. 'The realignment works both ways. Some of the voters Republicans have lost are upscale suburbanites who are fiscal conservatives.' 'Republicans tried to do privatised Social Security accounts; A to Z budgeting; baseline budgeting; line-item veto; balanced budget amendment,' he added. 'We've tried all those innovations, none of them resulted in winning elections. Culture does result in winning elections and so Donald Trump just came along and made the party about culture and not conservative economics.' David M. Drucker, Tribune News Service
Gulf Today
2 days ago
- Gulf Today
Adding work needs to Medicaid isn't a bad idea
Over the past 46 years that I've been part of America's job training system, work requirements for government benefits have been proposed several times. Each time these work rules have been initially denounced by opponents as 'cruel,' 'punitive,' 'blaming the victim' — with accompanying fears that benefit recipients were not ready to be employed and would lose needed benefits. Yet each time work requirements have been implemented, they have resulted in increased employment and other life benefits for a significant segment of participants, their families and local communities. Those are the metrics by which to measure success; reducing the rolls of benefit programs has not been the main goal sought by advocates of previous work requirements. The results have been documented over the years by scholars representing a range of viewpoints: Harry Holzer of Georgetown, Lawrence Mead of New York University and the professional research staff at MDRC, to cite a few. These results have been seen with work rules imposed for welfare recipients, recipients of various General Assistance benefits and parents who owe child support. They will be seen again if the proposed Medicaid work rules go forward and are implemented seriously and with purpose. Individuals on welfare and other benefit programs often need a push into the job world. They may lack confidence, have become discouraged or have no idea how to get started. Work rules provide that push. They also provide a support network for job placement and retention. America Works is one of the nation's largest job agencies serving unemployed people, referred by various government benefit programs. Each participant is assigned a job counselor and develops an individual employment plan. The counselor is to identify job openings, assist the participant in applying, advocate for the participant to employers. The counselor is also trained to be the coach whom all job seekers need: keeping spirits up through the (likely many) rejections, serving as a problem solver during the placement process and troubleshooting when job issues inevitably arise after placement. At each stage, the participant is no longer on their own. Since the early 1980s, work rules have been most extensively tested, studied and monitored in the welfare system, first as pilot projects by individual states and later under the federal welfare reform of 1996. Welfare scholars of the 1980s, including Manpower Demonstration Research Corp. President Judith Gueron would highlight how much previous welfare policies divorced from work requirements had underestimated the work orientation and strengths of welfare recipients. Researchers of welfare-to-work programs of the 1990s and early 2000s at the Urban Institute and with a consortium of university centers would confirm the widespread work orientation of welfare recipients, as well as their abilities to function in the work world. This is not to romanticize welfare-to-work. Despite the counseling and supports (transportation subsidies, child-care subsidies), a good number of participants drop out during the placement process or within a year of job placement. They do so because of chaotic personal lives or mental illnesses or developmental disabilities that the job placement system is unable to address. They do so because of an absence of a family network, or because they don't want to risk the other housing, healthcare and food stamp benefits they receive beyond the welfare payment. Even those who obtain jobs often struggle economically. At the same time, for those who are able to maintain a job, the job frequently brings values beyond the income. Jason Turner, the architect of the early Wisconsin welfare-to-work successes and later commissioner of New York City's Human Resources Administration, references the power of the job, drawing on his experiences over four decades. A job brings structure to participants in work requirement programs, somewhere to go every day. It brings a new confidence, which can translate into addressing daily life responsibilities that previously seemed overwhelming. In theory, the importance of employment is hailed across the political spectrum. In practice, though, the ties of government benefits to employment have been weakened in the past two decades — and so many opportunities to demonstrate the value of this connection have been missed. Welfare-to-work requirements have been diluted in major cities and blue states. Employment efforts for recipients of Supplemental Security Income and Social Security Disability Insurance have stalled. Guaranteed incomes schemes removed from employment have gained currency.
Gulf Today
3 days ago
- Gulf Today
Why Medicaid work requirements won't work
Kathryn Anne Edwards, Tribune News Service The US labour market is a truly astonishing thing to behold. It includes 171 million Americans, as young as 14 and older than 90, some who never finished elementary school and others with PhDs. It is resilient and dynamic, shrinking during recessions but growing again after. It provides the majority of Americans with the majority of their income. All of which is to say: It is common to look to the labor market as a kind of salve for all economic wounds. Whatever the problem is, the solution is to get people working. Unfortunately, it's not that simple. For all its strength, the labor market is encumbered by the low-wage labor market — where work doesn't support a stable living, and where jobs are so bad they're more salt than salve. This is a reality that Republicans in Congress, in their current push to impose work requirements on Medicaid recipients, ignore. They are making policy for a labor market that doesn't exist. The 'low-wage labor market' is a vague designation. It's typically defined as those workers who have relatively or absolutely low hourly earnings, such as the bottom quintile or quarter of wage earners, or earners below some nominal wage cutoff. Whatever the definition, however, there are some aspects of the low-wage labor market that are obvious: The low-wage labor market is large. At least 39 million workers in the US earn less than $17 an hour, which is the equivalent of $35,360 annually. That is just below 138% of the poverty threshold for a family of three — the income needed for parents to be eligible for Medicaid in states that expanded it under the Affordable Care Act. Earnings in the low-wage labor market are volatile. Earnings volatility measures change in wage income from one month to the next. Instability at both the very top and very bottom is so great that economists have a term for it: the 'wild ride.' Recent research from the Brookings Institution's Hamilton Project shows that low-wage earners see more spikes and dips in income than any other group, with the dips being especially large. They have the most volatile earnings when measured by the coefficient of variation, regardless of whether the household has a single or multiple earners. That volatility can be partly attributed to unpredictable hours. Many low-wage earners are employed in shift work, in which their hours and schedule can vary week to week, often with little notice. According to Harvard's Shift Project, two-thirds of workers in retail and food service get less than two weeks' notice of their schedule, half get less than one week's notice, and 70% report that the timing of their scheduled shifts changes at least once a month. This flexibility is more likely to be imposed by employers rather than requested by employees; the more volatile the hours, the fewer hours typically worked. Low-wage jobs usually also have low-quality benefits. Of private-sector workers in the bottom 25% of the wage distribution, 30% do not have access to any type of leave, whether it is sick, holiday, vacation or personal. Some 56% do not have access to an employer-sponsored health-care plan, while 84% do not have access to an employer-sponsored dental plan. And 50% do not have access to a defined-contribution retirement plan. The bottom line is clear. Working Americans are eligible for social benefits such as Medicaid not only because their pay isn't high enough, but also because it isn't reliable enough. Classic labour theory holds that workers are balancing two conflicting goals: the consumption of purchased goods, and the consumption of leisure time. The former requires time at work; the latter requires time away from work. It is up to the worker to calibrate how much of each they want. Of course, economists will try to predict how workers and consumers will react to any change in their earnings. If a worker gets a wage increase, the 'income effect' would push them to work less: They can still consume the same amount of purchased goods but also have more leisure time. Alternatively, a wage increase could trigger the 'substitution effect,' pushing them to work more: The price of leisure (foregone wages) is now more expensive. But what if that worker gets a non-wage increase from a public benefit? There is no substitution effect, just the income effect — that is, they would work less. This is the economic foundation for the idea that public benefits discourage work. Work requirements are meant to counter this incentive. It sounds reasonable. But for at least 39 million Americans, work brings low wages, unstable earnings, unpredictable hours and few benefits.
