Work Requirements for Medicaid Expansion – and an Obama Judge

Where do you even begin – when trying to explain Medicaid today and how President Trump is seeking with forward-thinking governors, to improve it, make it accountable, raise employment and reduce dependence?  Let’s begin here.

NBC, of all media outlets, reported in late 2018 that America was facing a “critical” labor shortage. What they omitted was the reason.  This was the flip-side of record low unemployment across virtually every demographic, resulting from lower taxes, less regulation and record economic growth, the product of President Trump’s free market economic policies.

Never mind the omission.  A “critical” labor shortage exists. At the same time, resulting from President Obama’s expansion of Medicaid benefits to all below 138 percent of the poverty line, at least 72 million Americans are on Medicaid, receiving federally-funded Medicaid benefits.

Of this total, roughly 35 million are children, leaving 37 million Medicaid-covered adults.  Today, 33 States and DC have accepted the expanded Medicaid coverage, with three states pending. 

Other states have said they want less federal dependence, not more.  They want waivers to allow reduced dependence on matching Medicaid coverage, including a lower threshold for benefits or work requirements. 

In early 2018, President Trump agreed to allow work requirements to be placed on able-bodied recipients of Medicaid, if states petitioned for such a provision. Two states that petitioned to add work requirements for Medicaid benefits going to able-bodied recipients were Arkansas and Kentucky.

President Trump’s Health and Human Services Department said “yes” – and granted the petitions.  So all cards on the table, understand this: the work requirements that went into effect in mid-2018 were clear: “Medicaid recipients were required to work, search or train for work, or volunteer for a total of 80 hours a month.”  That was it. 

This set of requirements – just 20 hours per week or four hours a day for five days a week – would have pressed 17,000 to “work” for benefits in Arkansas alone.  The “critical” job shortages in some sectors (including retail and those requiring minimal training) would have been addressed, costs to the State and Federal Governments reduced, engagement and productivity of the labor force raised, along with self-esteem and self-reliance.  Since health benefits are often attached to employment, the costs of Medicaid coverage itself would likely have fallen.

But last week an Obama-appointed judge – in a world where Chief Justice Roberts insists there are “no Obama judges,” meaning none with a political agenda tied to the former President – blocked the Medicaid work requirements in both Arkansas and Kentucky. 

Suddenly, Arkansas was back in the Obamacare stew pot, having to come up with eight billion dollars or boil.  Medicaid expansion was before them –suddenly stripped of work requirements, for which they had been given a waiver.  Their state program and the President’s waiver were undone by another stand-alone federal judge – one man.

So, what happens now?  Thoughtfully – and he is always thoughtful – Governor Asa Hutchinson, a former Congressman, former head of DEA and former high ranking DHS leader – has asked President Trump to appeal this federal judge’s unfair ruling.  For starters, the President should do that – and likely will do so swiftly. 

What else should happen?  Three things. 

First, other state governors should have the courage to apply for and implement limits on Obama-era Medicaid expansion, including work requirements for able-bodied Medicaid recipients. 

None of this affects Medicare recipients by the way, who are older Americans.  On the other hand, it does affect who works in America and on what terms they get benefits, what is expected of able-bodied citizens in our free society, and state and federal budgets.

Second, President Trump should use this as a springboard for discussing the Republican approach to medical care.  The safety net that should be in place, adopting pieces of Presidents Reagan’s, George Herbert Walker Bush’s and Bill Clinton’s approaches, should require work of able-bodied Americans; use tax credits and pooled purchases from private networks to keep quality up and costs down, and assure pre-conditions are covered.  Good economics and good health care can dovetail.

Third, this federal decision makes one last point:  In a world where one individual judge can upend all national security, immigration policy, border integrity, sanctity of life, and accountability in federal entitlements, President Trump needs to nominate – and the Republican-controlled Senate needs to confirm – as many strict constructionist, limited government,  constitutionally conservative judges as possible. 

In the end, the Medicaid debate – how to limit expansion, keeping the system accountable, affordable and effective – is part of a larger debate.  Limited government is under fire.  Thankfully, President Trump and a selection of governors still subscribe to the founding concept.  Let’s hope it gains traction ahead.  If there were ever time for limiting government, it is now.