Improving Medicaid Just a Little

No, President Trump is not ending Medicaid as we know it. Not even close. Like the Republicans in Congress, he is a welfare statist who has no philosophical objection to the existence of Medicaid or any other welfare program. Just look at the “Democratic” budget Trump submitted to Congress last year.

But the Trump administration has issued new guidelines via the Centers for Medicare & Medicaid Services that allow states to impose work requirements for able-bodied individuals to receive Medicaid.

Predictably, liberals are horrified.

Mary Beth Musucemi, associate director of the Kaiser Family Foundation’s Program on Medicaid and the Uninsured, said the new approach “will penalize individuals by having them lose health coverage, rather than incentivize them, as a voluntary program with adequately funded supportive services necessary to overcome barriers would.”

Eliot Fishman, senior health policy director at the consumer health lobby Families USA, called the new policy “unconscionable and illegal,” and said in a statement: “Today’s announcement isn’t about work. It is about taking away health insurance from low-income people.”

Before looking at the general idea of welfare work requirements, we should first look at two things: 1. What exactly is Medicaid? 2. What exactly is the Trump administration’s new policy?

Medicaid is government-funded health care for poor Americans of any age and people with certain disabilities. It is the third-largest federal domestic program (after Social Security and Medicare) and the primary source of health-insurance coverage for low-income populations and nursing-home long-term care. Medicaid is a means-tested welfare program jointly financed by the federal government and the states, but designed and administered by the states within federal guidelines. The federal government pays states a specified percentage of program expenditures that ranges from 50 percent to 79 percent of the program’s cost, depending on the states’ per capita incomes. Total Medicaid spending for fiscal year 2016 was $574.2 billion.

According to the Kaiser Family Foundation, Medicaid provides health-insurance coverage to 33 million children and 19 million adults in low-income families and 16 million elderly and disabled persons, assists 21 percent of elderly and disabled Medicare beneficiaries, and provides long-term care assistance to 1.5 million institutional residents and 2.9 million community-based residents.

The Trump administration’s new policy was laid out in a January 11, 10-page letter sent to state Medicaid directors by the Centers for Medicare & Medicaid Services:

The Centers for Medicare & Medicaid  Services (CMS) is announcing a new policy designed  to assist states in their efforts to improve Medicaid enrollee health  and well-being through incentivizing work and community engagement among non-elderly, non-pregnant adult Medicaid beneficiaries who are eligible for Medicaid on a basis other than disability.

States will have the flexibility to identify activities, other than employment, which promote health and wellness, and which will meet  the states’ requirements for continued Medicaid eligibility. These activities include, but are not limited to, community service, caregiving, education, job training, and substance use disorder treatment.

Subject to he full federal review process, CMS will support state efforts to test incentives that make participation in work or other community engagement a requirement for continued Medicaid eligibility or coverage for certain adult  Medicaid  beneficiaries  in demonstration  projects authorized under section 1115 of the Social  Security Act (the Act). Such programs  should  be designed to promote better mental, physical, and emotional  health in furtherance of Medicaid program objectives. Such programs may also, separately, be designed to help individuals and families rise out of poverty and attain independence, also in furtherance of Medicaid program objectives.

Ten states (Arkansas, Arizona, Indiana, Kansas, Kentucky, Maine, New Hampshire, North Carolina, Utah, & Wisconsin) have asked the federal government for permission to make Medicaid eligibility for able-bodied adults contingent on some sort of work activity. Three other states (Alabama, Idaho, & South Dakota) are considering the same action. On January 12, Kentucky became the first state to receive federal approval to require many of its Medicaid recipients to work in order to receive coverage. Under the new rule: “Adults age 19 to 64 must complete 80 hours of ‘community engagement’ per month to keep their care. That includes working a job, going to school, taking a job-training course or volunteering.”

Medicaid as we know it should be ended, not just altered or reformed by instituting work requirements for some of its recipients. Here are some reasons why.

Medical care for the poor, the disabled, the aged, the pregnant, or anyone else is an illegitimate function of government.

The Constitution nowhere authorizes the federal government to pay for anyone’s medical care.

Medicaid is socialistic, fosters dependency on the government, shifts responsibility from the individual and his family to society and the state, contributes to class warfare, and crowds out real charity.

Medicaid is an income-transfer program, a wealth-redistribution plan, and a social-engineering scheme.

No American should be forced to pay for the health care of another American. The government cannot provide medical services for one American without first confiscating the resources of another American. No American has a right to the resources of another American, no matter how low his income or how high his need for medical services.

There is no right to health care that it is the duty of government to provide or enforce. Health care is not a human right. It is a service that can and should be provided by the free market just like haircuts, auto repair, and recreation. If one cannot afford it, then the only alternative is charity. But all charity should be voluntary. One reason health care is so expensive is because of government intervention in the health care and health insurance markets. Government should not be involved in any way in either one.

And of course, it’s not just Medicaid. There are in the United States about 80 means-tested welfare programs that limit benefits or payments on the basis of the beneficiary’s income or assets. Programs like food stamps, the State Children’s Health Insurance Program (SCHIP);

Women, Infants, and Children (WIC); Section 8 housing vouchers; Temporary Assistance to Needy Families (TANF); Supplemental Security Income (SSI); school breakfast and lunch programs; the Low Income Home Energy Assistance Program (LIHEAP); and refundable tax credits like the Earned Income Tax Credit (EITC).

So, what about welfare work requirements?

Since providing welfare is an illegitimate function of government that is immoral because it forces some Americans to provide charity to other Americans with what is left after the money that is taken from them is used to maintain an army of bureaucrats, anything that government does at the federal or state level to reduce welfare benefits, reduce the number of people eligible for welfare, make it harder for people to qualify for welfare, or make it harder for people to stay on welfare has to be a good thing. No matter why the government does it.

This would have to include welfare work requirements. This, in fact, would have to include any requirements.

If the government cut welfare benefits for just some recipients, that should be applauded. If the government limited welfare to people with red hair, that should be celebrated. If the government required people to do a back flip to receive welfare, that should be lauded. If the government mandated that welfare recipients loose weight every month to continue to receive benefits, that should be cheered.

No one has a right to receive welfare benefits no matter how poor, sick, indigent, disadvantaged, hungry, needy, underprivileged, destitute, or desperate he is.

Welfare should not exist. But since it does, anything the government does to limit the amount or duration of its benefits or the number of its potential or actual recipients is a good thing.

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