Republicans are making the American Health Care Act even crueler to Medicaid recipients
Dylan Matthews
The American Health Care Act — House Speaker Paul Ryan's and President Donald Trump's proposal to replace Obamacare — was in its original form a truly massive cut to Medicaid. It slashed the program by $880 billion over 10 years, according to the Congressional Budget Office. It would eventually unwind the Medicaid expansion included in the Affordable Care Act and slash the yearly growth rate for Medicaid spending, forcing states to provide worse coverage or to kick people off the rolls.
Now it’s about to get harsher.
The “manager’s amendment” changing the legislation, which is set to be released Monday night by House leaders and expected to be adopted through a House Rules Committee vote before the full House votes on Thursday, includes new provisions cracking down on Medicaid beneficiaries. The changes would allow states to impose work requirements on able-bodied childless adults getting Medicaid, and to receive funding in a "block grant" that doesn't rise at all with enrollment, which would likely amount to a still-larger cut.
The amendment would also eliminate federal funding for Medicaid beneficiaries making over 133 percent of the poverty line — a cut that would hurt states like New York that have generous Medicaid programs. And it would cut off states’ ability to join the Medicaid expansion immediately, before phasing out the expansion for states that joined before March 1 of this year.
The measures were reportedly adopted to win over House conservatives, like Republican Study Committee’s leader Rep. Mark Walker (R-NC), who vocally opposed the bill at first. Walker is now on board with the plan after securing the Medicaid changes. “The president asked us specifically: Would we support him on this American Health Care Act [with the increased Medicaid restrictions]," Walker told the Washington Post's Mike DeBonis. "We all agreed, to a man.”
The original legislation was already a historic cut to aid for the poor. “No legislation enacted in recent decades cut low-income programs this much — or even comes close,” the Center on Budget and Policy Priorities’ Robert Greenstein told me when the CBO’s score was released. But the two new provisions — allowing work requirements and enabling states to take a block grant — are both major changes that will diminish access to Medicaid even further. They make a bill that already represented a historic cut to the health care safety net for poor Americans even more harmful.
Work requirements are ineffective across the board but especially on health care.
Work requirements are one of those ideas that have some intuitive appeal to taxpayers and voters — why should we pay taxes to help people who aren’t even working? — but which in practice don’t do much of anything to encourage work or cut poverty.
The best evidence we have on work requirements comes from experiments conducted in states in the late 1980s and early '90s, when the federal government gave out waivers to let state and local governments experiment with welfare-to-work approaches. Those experiments were usually done rigorously, with recipients randomly assigned to traditional welfare or welfare-to-work programs.
Last year, Center on Budget and Policy Priorities' LaDonna Pavetti took a look back at that experimental literature. In most studies, welfare requirements really did lead to an increase in the share of recipients working, in the first year or two. But only three experiments out of 13 still found significant positive results after five years; two experiments actually found that work requirements reduced one’s odds of working five years later. Overall, the policy didn’t seem to promote work much at all.
Even when work requirements worked, the effects were modest. The program in Riverside, California, the most effective at promoting work of the ones Pavetti analyzed, raised the percentage of welfare recipients working by 5 percentage points by year five. That's good, but it was ultimately an increase from 39.9 percent to 44.9 percent. Huge numbers were left not working and were no longer eligible for benefits either. Worse, subsequent research suggested that the Riverside program’s success at promoting work was a fluke, the product of an already stronger local economy rather than any reforms.
Indeed, Riverside's work requirements did not significantly change poverty rates, relative to a control group without requirements. In only two out of 13 experiments, in Atlanta and Portland, did work requirements significantly cut poverty, and even then the effect size was small. In Portland, 83.4 percent of those not subject to work requirements were in poverty, but so were 79.4 percent of those subject to them.
The evidence, Pavetti concluded, was clear: In most cases, work requirements didn’t cause more people to work, and when they do, the effect was small, and didn’t typically lead to much poverty reduction. The idea underlying work requirements — that there’s a large number of people on public assistance who should be working and aren’t because of laziness or inertia or whatever — just isn’t true.
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7, don't be disingenuous... if you disagree with my point, just disagree with my point... don't lie and say that the repugs aren't trying to roll back abortions....