The House GOP’s Limit, Save, Grow Act to raise the debt ceiling contains within it a vitally important reform — work requirements for able-bodied adults to qualify for Medicaid.
While the Congressional Budget Office estimates the Medicaid work requirements in the bill will save $109 billion over the next 10 years, the money savings are not why the reform is so important. In fact, work requirements for welfare programs are vital for the health and wellbeing of those receiving benefits.
The House GOP Medicaid work requirements build on the highly successful reforms to unemployment insurance and other welfare programs Republicans enacted in 1996.
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These reforms passed in a bipartisan fashion (Republicans split the Democrats in the House, and it was signed into law by a Democratic president) because we made the case that fixing these programs were a moral imperative more than a fiscal one.
Prior to the 1996 reforms, our nation’s welfare system had become a poverty trap. That’s because its focus was on making poverty less uncomfortable rather than lifting people out of poverty. The dignity of work was disregarded.
Republicans, along with most Americans, understood that work is essential for lifting people out of poverty. Our reforms re-centered the welfare system around the importance of work and rewarding people for working.
In addition to work requirements, Republicans made changes to the way benefits were calculated to avoid penalizing people for earning more money. By ensuring that more work equaled higher net income, we transformed the program from a quagmire of dependence into a ladder to independence.
The results were dramatic. Within five years the United States experienced a 50% decrease in welfare caseloads accompanied by a dramatic drop in child poverty and rise in household income, particularly among households headed by unmarried women with children.
The results prove that work requirements for public assistance are a compassionate policy because they create the best conditions for the wellbeing of the people on the programs.
Including work requirements in Medicaid would build on that success. There is ample evidence that Medicaid coverage without work requirements creates a disincentive to work. In 2005, Tennessee disenrolled 170,000 individuals — 91% of whom were childless adults. A 2013 analysis from NBER found "an immediate increase in job search behavior and a steady rise in both employment and health insurance coverage."
Incorporating work requirements in Medicaid would also be better for the health of enrollees. That’s not only because of the wealth of research linking higher income with better health outcomes, but also because more time in the workforce leads to better jobs that provide health benefits — which are typically far better than what one receives on Medicaid, in terms of access to quality care.
Future reforms to Medicaid, which can be applied at the state level, should emulate the reforms to benefit calculation we made in 1996 so that working more does not lead to a reduction in health benefits. One way to accomplish this would be to adopt premium assistance flexibilities that allow working Americans to combine the value of employer sponsored and Medicaid benefits to purchase individual insurance that meets their needs.
Work requirements for public assistance programs are also important to maintaining public support for the programs. Americans are compassionate people, but they believe those receiving benefits have responsibilities.
In addition to the responsibility to be working or looking for work, we should explore tying government provided health care coverage to other expectations for healthy behavior. Polling done by our two organizations, America First Policy Institute and America’s New Majority Project, shows that 74% of Americans agree that those on Medicaid have a special responsibility to maintain a healthy lifestyle.
As conservatives, we recognize this needs to be done with a light touch, because we do not want the government to be overly invasive. But there are certain things that can be done.
One idea would be to require Medicaid enrollees to complete an annual physical or health screening to maintain coverage. Since catching health issues early leads to better health outcomes and less overall spending, this requirement to practice preventive medicine would be better both for the Medicaid recipient and the taxpayer.
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Giving Medicaid enrollees access to direct primary care physicians who typically have smaller patient panels, which results in expanded access to clinicians — including longer office visits and same-day or next-day appointments — can ensure Medicaid patients can easily obtain this sort of preventive medicine.
In addition, since there is a large overlap in those on Medicaid and those utilizing food stamps, Congress and the president should use the upcoming reauthorization of the farm bill to make reforms to incentivize the use of SNAP benefits to purchase nutritious food that improves health, rather than purchases that cause more health problems. The "N" in SNAP stands for Nutrition, after all.
Now that the House has passed a debt ceiling increase that includes these and other vital reforms, President Joe Biden and Senate Majority Leader Chuck Schumer will no doubt attempt to remove the work requirements as part of any negotiations on a final bill.
Just like in 1996, the left will attack work requirements as being cruel to the poor. Speaker Kevin McCarthy and House Republicans should take a lesson from our success to make the case that in fact they’re about more than saving money — they’re for the health and wellbeing of those receiving benefits.
Bobby Jindal was the governor of Louisiana from 2008-2016 and a candidate for the 2016 Republican presidential nomination. He chairs the Center for a Healthy America at the America First Policy Institute.
