The AHCA Now Proposes Work Requirements on Medicaid: Does Linking Work with Assistance Help or Harm?
The concept of requiring work in exchange for public assistance to reduce dependency and number of recipients dates back to 1990’s welfare reform, which resulted in Temporary Assistance for Needy Families (TANF). In fact, numbers of TANF recipients did go down, but it’s debatable whether that reduction was due to larger numbers entering the workforce in long-term, sustainable jobs, or just fewer people being able to meet TANF requirements.
Helping individuals find a way to employment and economic mobility, including providing necessary supports to overcome barriers to sustained employment, is essential. TANF looks at distinct barriers, e.g. someone without transportation may need help just getting to work, a parent with young children may need affordable and safe child care, and so on, and allows states to use the funds to address these issues. Beyond the structural, funding, and levels of flexibility issues of concern that have arisen in TANF, it does stand as an example of how public assistance programs can help in authentic ways. Imposing work requirements, without adequate supports poses serious problems. For example, parents without access to quality and affordable childcare will often leave them in the care of a relative, a friend, or an older sibling. These caretakers are not always qualified for the appropriate care of young children. The Commission to Eliminate Child Abuse and Neglect Fatalities (CECANF) noted this as a serious risk factor in child deaths. Several 2008 child deaths in Wichita, Kansas occurred when children were left by their mothers with relatives or acquaintances in order to go to work or tend to a medical issue.
The necessity for additional supports in TANF were substantiated in a 2016 Congressional Research Service (CRS) report, requested by the House Ways and Means Committee. The CRS report found that to achieve the economic well-being of families with children, work had to “pay more” than cash assistance; additional work supports were necessary. The supports that have strengthened the ability for individuals to meet TANF’s work requirement include major expansions of the Earned Income Tax Credit (EITC), major expansion of the Child Care and Development Block Grant (CCDBG), and extended health insurance coverage such as transitional Medicaid and the Children’s Health Insurance Program (CHIP).
The current version of the American Health Care Act (AHCA) proposes a work requirement for some Medicaid recipients, but the requirement is not accompanied by the resources that would support employment assistance, job training, or additional family supports.
The lack of resources provided through the AHCA-proposed Medicaid amendments are just part of the risk.
Adding work requirements to a program providing health coverage is much different than requiring work for an assistance program that is designed to lend a financial path between jobs and during times of economic distress. Data indicates that most Medicaid beneficiaries who can work already do so. Three-quarters of non-elderly adults and children enrolled in Medicaid live in a family with at least one worker. Therefore, work requirements are not likely to reduce the number of recipients enrolled in Medicaid. Many of those who are not working or have a reduced ability to work are likely already relying on public assistance due to significant health challenges or family responsibilities. Medicaid has allowed those with chronic conditions to get treatment and return to the workforce.  Using health care as a sanction for failing to meet work requirements is counterproductive in linking people to work or increased work.
Lastly, much more rigorous research on mandatory work requirements and what a successful structure would look like needs to take place before implementing them on a program that provides healthcare to children, adults, and seniors, and often pays for life-saving treatment. “An evaluation of a major employment program demonstration for public housing residents, Jobs-Plus, shows that a voluntary program targeting non-disabled adults with work-focused encouragement, information, incentives, and employment assistance can increase earnings and employment for groups with historically low labor-force participation rates.” So far, these results have not occurred with mandatory work programs.
Continued Reading on adding work requirements to public assistance programs:
 “Within Our Reach” http://www.cwla.org/wp-content/uploads/2016/03/CECANF_Final-Report_Embargo-until-3.17.16-1.pdf