“Expanding Work Requirements in Non-Cash Welfare Programs,” issued in July, states, “self-sufficiency has been declining in recent decades while material hardship has fallen, motivating a renewed focus on building self-sufficiency via work requirements.”
Lured into Dependency
Charles Katebi, a state government relations manager with The Heartland Institute, which publishes Health Care News, says Medicaid can seem attractive to recipients but then trap them in dependency.
“On paper, Medicaid offers a very generous package of benefits,” Katebi said. “Basically, you’re given this card and there are no copays and no deductibles, and in theory you can see a doctor. When people see those baseline numbers, they think, ‘What’s going to happen to my health coverage if I earn too much money? What’s going to happen to my Medicaid card?’ So they instinctively decide to work fewer hours or not work at all, to keep those benefits.
“In 2015, the congressional budget office estimated that as a result of Medicaid expansion alone—not the program overall, but just the Obama expansion—2.5 million currently working Americans would drop out of the labor force or work fewer hours,” Katebi said.
Dr. Jane Orient, executive director of the Association of American Physicians and Surgeons, president of Doctors for Disaster Preparedness, and a policy advisor to The Heartland Institute, says individuals receiving free health care do not seem to appreciate it as much as those who pay their own way.
“My experience with entitlement patients is that they tend to be demanding, sometimes abusive, and unlikely to follow your advice,” Orient said. “They believe that the doctor is being well-paid, probably too well-paid, and that they should get VIP service.”
Orient says she does not accept Medicaid patients at her practice.
“I never have and never will take Medicaid,” Orient said. “The process of applying for payment is demeaning, complex, timewasting, and fraught with risk of being accused of fraud for a billing error, violating some rule, or doing something unnecessary. Doctors who do take Medicaid are always having to fight the system to get what their patients need. And patients frequently don’t keep appointments or show up late, disrupting the rest of the practice. [It is] far better to help people for whatever they can afford to pay.”
‘Incentives That Trap People’
Critics of the White House report claim the 2013 Census Bureau data used to compile it, collected before multiple states expanded their Medicaid programs in 2014, portrays an inaccurate picture of non-workers, a complaint Katebi says is unfounded.
“If the White House picked a year such as 2009 or 2010 to make the case that Medicaid is full of unemployed people, there may have been room for suspicion,” Katebi said. “We had just been hit with a financial crisis, and people often float onto Medicaid rolls at such times, but 2013 was after years of economic growth and a return of economic opportunities, so people should have gone back to the workforce.
“Years later, you still see so many people on the program,” Katebi said. “I think that’s proof the program still has some really bad incentives that trap people, even when there’s millions of jobs available, as we see in the data.”
Council of Economic Advisors, “Expanding Work Requirements in Non-Cash Welfare Programs,” Executive Office of the President of the United States: https://www.whitehouse.gov/wp-content/uploads/2018/07/Expanding-Work-Requirements-in-Non-Cash-Welfare-Programs.pdf