Georgia is the first state to adopt work requirements for Medicaid enrollment among adults. Critics say it is off to a rocky start, while proponents say it’s working as designed. Very few people are going to the trouble of providing proof they are working or trying to find work. Policy analysts on the Left dismissed the idea draconian, difficult to enforce and a barrier to care for those who need it. Proponents argue anyone asking for public support should show some evidence they are trying to support themselves.
Whether work requirements are working or not is subject to debate and disagreement. As an economist I suspect the revealed preference is that potential Medicaid enrollees value Medicaid so little that they are not even willing to exert minimal effort to prove they are eligible. Perhaps they do not want to work, or perhaps they find the process daunting. Or bureaucracy is confusing and a pain in the caboose.
Why does this discussion matter? Opponents who support Medicaid expansion (some who welcome Medicaid for All), fought the proposal until Donald Trump won his second term in office as president. Now they must take the policy seriously since the Trump Administration supports Medicaid work requirements. As an aside, I would argue work requirements should be part of all entitlement programs. Many other states headed by Republicans plan to institute work requirements for Medicaid enrollment. Indeed, a recent poll finds that the majority of voters (60%) support work requirements in Medicaid, including 47% of Democrats. Back-of-the-envelope math suggests that nearly three-quarters of Republicans support work requirements. Oddly enough, very few (17%) said they support cuts to Medicaid. Forty percent wanted funding kept the same, while 42% supported increasing Medicaid funding. The take-away for policy makers is the vast majority of Americans, both Democrats and Republicans, support Medicaid but believe recipients should have to work if they are to expect help in the form of taxpayer-funded medical care. Just over half of those responding to the poll said they, a family member of someone they know, had Medicaid coverage at one time or another.
If the results in Georgia are replicated across other states, adopting work requirements would have the effect of cutting Medicaid spending. That is certainly a valid method to decide who gets cut and who gets to keep Medicaid coverage. Let the recipients decide. Many of those polled mistakenly believe most Medicaid enrollees are unemployed when most have jobs. Republican voters also support caps on federal spending and even favor reducing the matching rate for Medicaid expansion under the Affordable Care Act (currently at 90%). Two-thirds of Republican voters (64%) support reducing the federal match for Medicaid expansion and 40% of voters overall. Again, back-of-the-envelope calculations put the number of Democrats supporting that measure at nearly one-in-five. (Block grants, anyone?)
A variety of factors reduced peoples’ views. When told millions would lose coverage support fell but rose again when told the federal budget would save $600 billion.
“Medicaid is a very popular program among a wide swath of the public including Republicans,” said Mollyann Brodie, KFF’s executive director of survey research.
But, she added, “opinions could be quickly moved in the context of debate where people learn more information and feel their coverage is threatened.”
The bottom line is that people support charity when they perceive it is free, but backstep when they realize charity is not free. That would not come as a surprise to economists, who are fond of saying more is preferred to less (until people must pay for it).
Read More at NYT: Republican Voters Support Medicaid but Want Work Requirements, Poll Finds
I have had relatives on Medicaid, so here are some observations:
1, You will lose Medicaid in many states if your income exceeds $1,669 a month. That comes to $10 an hour if you work full time. It is understandable that some recipients say they are not working when in face they are.
2. Young men in particular do not value Medicaid because they are dumb as a rock. They don’t have the needs that women do. They never get sick, unless you count hangovers.