Medicaid work requirements are a throwback to rejected racial stereotypes

Some myths just won’t die, no matter how odious or untrue. And in the Trump era of outright lies masquerading as “alternative” facts, it is no surprise that we are seeing decades-old canards creep back into, and muddy, policy debates. A new Trump administration policy does just that by encouraging states to place work requirements on people who want to receive health insurance coverage through Medicaid.

The Trump administration wants to decimate vital programs like Medicaid. But it can’t do that outright, so it wants to fundamentally change the way they work. Never mind that these sorts of mandates don’t work — numerous studies, including those from the Kaiser Family Foundation and the Center on Budget and Policy Priorities, confirm the inefficacy of work requirements in alleviating poverty or increasing employment over the long-term. Never mind that most Medicaid recipients already work if they are able to do so. Never mind that work requirements have never been allowed in the 50-plus years of the Medicaid program.

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And yet, Seema Verma, administrator of the Centers for Medicare and Medicaid Services, is touting work requirements as a way to enable individuals covered by Medicaid to “break the chains of poverty” and “live up to their highest potential.” We’ve been here before. Her remarks about work requirements could be mistaken for 1990s stump speeches touting welfare reform legislation. But that is the very point. Long rejected racial stereotypes, like the caricature of an “able-bodied” single mother of color “collecting” public benefits and willfully refusing to work while living a lavish lifestyle, have been successfully used to support “reforms” that actually limit eligibility for many programs like Medicaid.  

In fact, we don’t have to look any farther than welfare reform to find evidence that a Medicaid work requirement won’t help people find long-term employment or escape poverty. A study by the Center on Budget and Policy Priorities on the impact of work requirements in Temporary Assistance to Needy Families programs found that the large majority of individuals subject to work requirements remained poor, and some fell even further into poverty.

Another study by the Urban Institute found that TANF work requirements made no difference in long-term employment rates. In other words, many families were worse off after work requirements were implemented. There is no reason to think that Medicaid work requirements will be any more successful than those imposed in TANF and other social safety net programs over the last 20 years.

That’s why it’s important that we expose the argument for work requirements for what it actually is — an attempt to perpetuate myths that stereotype people of color and stigmatize popular public programs that opponents simply don’t like.

These racial stereotypes are not only ugly and hateful, they also obscure the actual lived experiences of people who are covered by Medicaid. For instance, most Medicaid enrollees who can work, do. According to the Kaiser Family Foundation, nearly 8 in 10 non-elderly adults on Medicaid in 2015 lived in working families, with a majority in the workforce themselves. They generally work in low-wage or minimum-wage jobs that offer either unaffordable health insurance or none at all. And many adults covered by Medicaid who are not working have commitments like caring for relatives, are pursuing an education, or have an illness or disability that prevents them from working.

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This nation created Medicaid to help these very people. Requiring individuals to meet work requirements threatens this coverage and forces many to risk their health or family’s well-being by having to decide between working or going without health insurance and needed medical care.

Work requirements are not a lever out of poverty as this administration would have the public believe. Instead, work requirements are a way to deny individuals access to vital health insurance coverage that strengthens families by making work, education, and other pursuits possible. Promoting Medicaid work requirements based upon negative racial stereotypes could literally mean the difference between life or death for some individuals who rely on Medicaid for their well-being and economic security.

Vanita Gupta is president and CEO of The Leadership Conference on Civil and Human Rights. Fatima Goss Graves is president and CEO of the National Women’s Law Center. Follow them on Twitter: @vanitaguptaCR‏ and @FGossGraves