Paul Ryan Adds Useless and Cruel Work Requirements to Medicaid

By Bryce Covert, ThinkProgress

23 March 17

 

It will cost vulnerable people their insurance without helping anyone actually find work.

he House is scheduled to vote on Trumpcare Thursday night, but it’s still up in the air whether Speaker Paul Ryan (R-WI) will have the votes to get it passed.

So in an effort to secure more votes from Republican lawmakers who feel that the legislation doesn’t go far enough, Ryan submitted a “manager’s amendment” on Monday that deepened many of its cuts. It includes a new provision letting states impose work requirements on people who enroll in Medicaid.

For all the talk of Ryan as a serious policy wonk, this policy won’t improve employment or earnings for Medicaid recipients?—?or even save money. Instead, it will just cut vulnerable people off from health care.

One rationale for forcing people who get their health insurance through Medicaid to work is that the expansion of the program under the Affordable Care Act incentivized laziness among recipients. It causes “idleness,” in the words of Rep. Jodey Arrington (R-TX), because it’s a “seductive entitlement.”

But the evidence shows the opposite is true. As a report from the Urban Institute notes, “Trends in employment status, number of hours worked per week, full-time work status, wages, and job switching were no different across Medicaid expansion and nonexpansion states following implementation.”

In fact, nearly 80 percent of adults on Medicaid live in a household where at least one person is working, while about 60 percent work themselves, most of them full time.

The reason they need Medicaid, then, is because they can’t get affordable health insurance from their jobs. By definition, these are people in low-wage work?—?an individual has to make $16,642 a year or less to qualify under the ACA’s expansion. Many of their employers may not offer plans they can pay for. Meanwhile, about 40 percent work at companies that are small enough to not be required to offer coverage at all under the ACA, and many of them work in industries that typically don’t offer it.

What this means is that adding a work requirement to Medicaid won’t affect the majority of recipients who already have a job. What it will do instead is threaten insurance coverage for those who have good reasons not to work. According to the Kaiser Family Foundation, more than a third say they aren’t working primarily thanks to an illness or disability, 28 percent say they are caring for their families or homes, 18 percent are in school, and 8 percent are retired.

A work requirement will likely mean that these people simply lose their health care coverage, given that it’s already difficult for them to work and it is usually administratively impossible to get an exemption. According to an analysis from Hannah Katch, a Medicaid expert at the Center on Budget and Policy Priorities, “The principal effect of imposing rigid work requirements in Medicaid would likely be to make it more difficult for many of these individuals to address their problems, by taking away their health coverage.”

On the other hand, having Medicaid appears to make working and finding work easier. In a report on enrollees in Ohio’s Medicaid expansion, more than half of those with a job said having that insurance had made it easier to keep working, while three-quarters of unemployed enrollees said it made it easier to look for a job.

Proponents of work requirements for safety net programs often back up their support by pointing to one large federal benefit that has one: the Temporary Assistance for Needy Families (TANF) program, or cash welfare. When welfare was overhauled in the mid-90s, lawmakers added a strict work requirement. Ryan himself has called welfare reform, including this addition, “revolutionary.”

But while reform was supposedly meant to get people “off welfare and into work,” the requirement hasn’t functioned as promised. In a study of Maryland’s experience, within the first year of being pushed off of TANF, more than a quarter of people had no job at all, while almost 40 percent either didn’t work or only worked for a small portion of the year. Five years later, the situation was even worse: 37 percent had no job at all, while more than 45 percent either didn’t work or worked only a bit each year.

In other states, former recipients who were pushed off thanks to work requirements worked at rates equal to or lower than those who weren’t subject to them. Any initial bump in employment eroded over a five-year period.

Instead, the share of low-income single mothers?—?one of the biggest groups served by welfare?—?who don’t get benefits but also don’t have a job rose over 15 years, from about one in eight in 1996 to one in five by 2008?—?now 1.2 million people total. By 2008, median family income for these mothers was just $535 per year. Per year.

Those who got jobs didn’t fare a whole lot better. In Maryland, more than half who had work experienced unstable, low, or falling earnings, and only 8 percent earned enough to escape poverty. Elsewhere, the majority of former recipients who had work only had unstable job situations, working less than three-quarters of a given year.

Pushing Medicaid recipients to get a job isn’t likely to even save money. Any proposed savings would come from people leaving the program to get insurance through work. But 60 percent of the program’s spending goes to caring for the elderly, people with disabilities and in long-term care, and children. None of them is likely to be able to get a job.

Instead, it could cost states even more money, adding thousands of dollars per recipient as they have to create new programs and staff to monitor whether recipients comply with the requirements.

A 6-Year Plan for Us and Humanity

By Ronnie Dugger, Reader Supported News

23 March 17

 

1

The American people, Democrats, Republicans, and independents, have been shown in poll after poll after poll to be demanding, by strong majorities, Medicare for all — single-payer national health insurance.

In the Republicans’ drive in Congress now to deprive 24 million people of their for-profit health insurance, Donald Trump has jeeringly exclaimed that all the Democrats can do is “delay, delay, delay.”

And he’s right. But the opposition leaders in Congress are so distracted and snarled up in Trump’s tweets, his open collusion with Russia against Clinton in the election last year, the Republicans’ and Trump’s proposed “American Health Care Act” for the billionaires against the poor, and now the Republicans’ morally rotten planned seizure of a Supreme Court seat that should have gone to President Obama’s nominee last year, that the Democrats have forgotten about what the people passionately want and their leaders should be again fighting for right now on a two- and a six-year plan.

Let’s step back from the Trumpdom & Daily Circus and do a little candid thinking together.

Since July last year the FBI has been investigating, as its director James Comey said Monday, whether the Trump campaign colluded in Russia with Putin’s operatives to swing the American election toward Trump over Clinton and, much to the point, whether crimes were committed in that conspiracy. This tells us, first, that late last year Comey went public against Clinton as the election was ending while he also stayed silent about the FBI’s active investigation of Trump and Russia conspiring to jimmy the same election. This means, second, that the Trump presidency is now in direct and serious danger of impeachment for colluding with Russia to win the presidential election of the United States.

Comey can get back the trust of the American people now by, as he promised Monday, continuing to follow the facts about Trump/Putin wherever they lead and, equally important, by immediately issuing a substantive first report from the FBI’s investigations about the Trump-Putin collaboration for the past nine months. After that he should give us regular candid and substantive reports, every two or three months or so, until the investigation is (in his maybe stalling-justifying word) “completed.” Nothing should outrank the public’s momentous right to honest reports from Comey on this historic investigation.

Senator Schumer of New York is correct, don’t you think, that the Gorsuch nomination to the Supreme Court should now be put on pause. Are these Republicans in Congress decent people, or are they shameless hacks for a lying President? If Gorsuch is cleared for the Court by the Senate majority with this pending over Trump, and after the FBI reports he is then impeached, Gorsuch’s nomination and therefore his Supreme Court seat would be invalidated; he would be subject to challenge as an illegitimate member among the nine justices.

Gorsuch is already, should we not think, (I do,) an illegitimate nominee because the Republicans unconstitutionally refused to give Obama’s nominee even a hearing for almost a solid year, and now are in effect physically seizing a seat on the Court that is not theirs to occupy. Under the circumstances, the FBI thunderstorm on its way, in self-defense Gorsuch himself should join Schumer’s call for a pause.

2

The big picture’s big question now, although it is seldom specified, is whether Trump will be impeached and ejected as President.

This depends, in substantial parts, on the facts about his and his team’s complicity with Putin against the U.S. election; his blatant and impeachable violations of the Emoluments clause of the Constitution by refusing to put ownership of his holdings into a valid Blind Trust, explicitly retaining his ownership of them, thus turning the Presidency into his personal profit center at the explicitly prohibited constitutional risk of damaging the national interest; and his now world-notorious limitless lying, crippling not only his personal credibility and his capability to fulfill his constitutional duty to see that the laws are faithfully executed, but most dangerously, as commander-in-chief of our military and sole decider on using our nuclear weapons, endangering us and all humanity of catastrophe up to nuclear war during imminently forthcoming international military crises.

The major polls should now be asking the public, should President Trump be impeached?

Whether he is or is not, the Republicans’ nomination of him and his election by fewer than half the voters have created a national emergency. And acutely because of his sole and exclusive control over our nuclear weapons and because of his hostility against our national steps to help prevent earth-threatening climate change, this is in truth and fact also an emergency for the human species and the continuation of life on earth.

This is all so shockingly serious that it is reasonable to expect, shouldn’t we think, that even the Congressional Republicans, shameless fact-immune partisans most of them are proving themselves to be, if it comes to it enough of them will do some twisted gut-checks and realize they, too, personally, will vote for the United States and the human race against the worst liar and blowhard in the history of our Presidency.

3

Back now to the present moments. As a people and individually we face together now not only the elections of 2018 but also those of 2020 and 2022.

Our elections are totally polluted and we the people raped by unlimited big-corporate and billionaires’ money. The “Supreme Court” has caused not only that, our supposedly nonpolitical supreme masters have also invented the non-law that corporations are human persons, their citizen-crushing “rights of free speech” lyingly outlasting, for example, even our human mortality. Congress has permitted the total militarization of our nation, the criminally unaudited misspending of our tax monies for our misnamed Department of War, and our military and our Presidents waging criminal and evidently permanent wars of aggression.

What we need, fellow citizens, is a six-year local and national plan to clean out — once and for all, for ourselves and for the human race — to clean out our White House, our Congress, our state legislatures, and the state capitols in each of our 50 states.

If Trump is not impeached and ejected, then in 2020 we have to re-elect him or elect his successor. We also face together during those next three election years the fact that we, us, you and I, will either defeat or elect every single member of Congress and the members of every state legislature throughout the United States.

Shall we not, then, take now the six-year view: Yes, Resist Trump! but also Yes! — Get to the actual work of focusing like laser beams on the persons who are our very own members of Congress and our very own state legislators and as well but not merely as usual on the Presidency and our statewide elected officials? All the new candidates, too — where are they on the issues that matter?

We need each nonprofit collaborating in resisting Trumpism to collect and distribute the votes cast by every incumbent official and what these votes mean, the candidates’ positions on the issues, whether that official or that candidate is a sellout or a reliably-enough supporter of the common good. Let them know we are informed and watching and they are accountable to us personally!

For example, during voting in committees or in the whole House or the Senate on the Ryan/Trumpcare bill gutting healthcare, the Democrats should get record votes on substituting, for the AHCA, single-payer Medicare for all. That will tell the people who are their friends and who are not. At every opportunity, from now to each forthcoming election — whether on a higher minimum wage, raising instead of lowering taxes on the rich and the gigantic corporations, an all-public-funds national infrastructure building program, adequate budgets for workers’ compensation, replacing cuts in public benefits with cuts in excessive military spending — with amendments and substitute motions, the Democrats should demand and get the record votes they need to show what they'll do for the people when they win again and to show up the real enemies of the people.

We can, if we can work together, decide that the organizations allied to save our country and humanity will, in planned concert, assign to specific organizations and persons among them the tedious, but vital work of giving complete attention to and recording of the Record Votes on the issues that matter. We need, matched to the candidates in the elections of 2018, 2020, and 2022, all the available salient record votes of every elected official in the country and in the states for the next six years. Target them!

The same goes for every candidate for any public office. To stop the lying that is now fundamentally accepted in our politics, which Trump incarnates, maybe before the campaigns we should devise contracts with us, the voters, that we require both candidates and officeholders to sign in advance. But that’s for later, I guess. Our democracy is and we are at mortal risk now. We need to just get organized, and get to know our neighbors in our own wards and precincts, and get going.

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Ronnie Dugger, founding editor of The Texas Observer and recipient of the 2011 George Polk career award in journalism, is now writing a book on the alleged nuclear ethics of nuclear weapons and nuclear war. He has published biographies of Presidents Lyndon Johnson and Ronald Reagan, books about Hiroshima and universities, and articles and essays in The Nation, Harper’s, The New Yorker, The New York Times, The Washington Post, and many other publications. His email is This e-mail address is being protected from spambots. You need JavaScript enabled to view it