The White House’s goal of consolidating federal safety-net programs in a revamped and renamed health department would fulfill a long-held conservative goal that has the potential to reduce federal help for the neediest Americans.
The Trump administration’s plan to reorganize the federal government also has an explicit aim of building standardized requirements that people must work or prepare for jobs to qualify for government help.
The blueprint does not itself contain funding cuts for food stamps, cash assistance, Medicaid or other longtime pillars of the government’s safety net. But it runs alongside President Trump’s efforts in his budgets to slash funding for such programs. And it would buttress a case for reductions by pulling together programs in ways that make clearer how much the government is spending.
The plan’s very lexicon embraces conservative branding of federal assistance for the poor. It proposes to change the Department of Health and Human Services, as it has been called since 1980, to the Department of Health and Public Welfare, reviving a term that has acquired negative connotations on the right.
Whether these changes are a good idea lies at the core of a deep philosophical divide about the proper size of government and its role for people who live in poverty or close to it.
“The federal government is bloated, opaque, bureaucratic and inefficient,” Mick Mulvaney, director of the White House’s Office of Management and Budget, said Thursday in unveiling the proposal, much of which would require Congress’s approval.
Robert Rector, a senior research fellow for domestic policy studies at the Heritage Society, who has advised Trump administration officials on ideas for safety-net programs that he has advanced for a decade, said, “You have to treat the welfare system holistically.” He said in an interview Thursday that the government could, for instance, align assistance programs to remove financial deterrents to marriage.
And Rector said that lawmakers, agency officials and the public are “looking at a jigsaw puzzle one piece at a time,” so that the overall amount of help going to single mothers with children is underestimated. Such women who work at minimum-wage jobs, Rector said, actually end up with earnings totaling about $35,000 a year taking into account federal tax credits, help from the Supplemental Food Assistance Program (SNAP) and the value of Medicaid benefits.
Other social-policy experts agree that greater coordination could be useful but are wary of the administration’s motives. Robert A. Berenson, an Urban Institute fellow who worked on health care and other domestic policies in the Carter and Clinton administrations, said the reorganization plan seems like “a politically driven, conservative thing. It becomes a target for cutting.
“If you think of all these programs . . . as simply part of public welfare, it’s something of a pejorative terminology,” Berenson said. It implies that “we are giving you special favors. We are doing it if we have some spare money around, as opposed to entitlement as a function of being citizens that meet certain eligibility,” Berenson said in an interview. Lumping Medicare, the federal health insurance for older Americans into which workers pay, as a form of welfare is particularly inappropriate, he said.
Ron Haskins, a Brookings Institution fellow who was President George W. Bush’s senior adviser on welfare policy, said the idea promoted by some conservatives that most low-income Americans receive all the government help for which they qualify “just isn’t true.” But Haskins is co-chairman of a Commission on Evidence-Based Policymaking that recommended consolidating data from various forms of economic assistance.
House Minority Leader Nancy Pelosi (D-Calif.) said in a statement: “At every turn, Republicans in the White House and Congress are sticking the American people with a raw deal on their health, education and economic security.”
Specifically, the White House plan for reorganizing the government would attach to the government’s health department two mainstays of federal food help run by the Department of Agriculture: SNAP, formerly known as food stamps, and WIC, a nutrition program for women, infants and children. Two smaller food programs also would move from Agriculture to a part of the renamed health department that currently oversees Temporary Assistance for Needy Families, the program of cash assistance that typically is considered welfare.
“These programs are designed to support low-income Americans, a mission area better situated in” the revamped health department, the plan says.
In addition, the plan would create a council with power to standardize programs across the entire government that assist low-income Americans. Notably, the proposal says, that power would include setting requirements that people work or prepare for jobs to receive federal benefits.
This year, the administration changed Medicaid rules to allow states for the first time to create work — or “community engagement” — requirements. More recently, the administration has been advocating for such requirements for a broader set of assistance programs for the poor.
Trump’s aides and other conservatives contend that such requirements are a means to help poor people become self-sufficient. Congressional Democrats and liberals, who argue that the requirements are a means to winnow Medicaid roles, contend that people in the program capable of working already have jobs and that others need health care to help equip them to work. The question of whether work requirements are legal is now before a federal court.
Margaret Weichert, deputy director for management at OMB, told reporters on a conference call Thursday that the consolidation would lessen “risk of improper payments and duplication” and would better align with the bureaucracies in states that administer many of the programs.
While the plan does not address how much money safety-net programs need, Trump’s two proposed budgets have envisioned deep cuts. The 2019 budget the White House proposed in February would cut Medicaid funding by $250 billion over the coming decade. And it would lower spending for food stamps by $213 billion — a reduction of nearly 30 percent — and Temporary Assistance for Needy Families by $21 billion.
The Trump administration also has called for replacing SNAP cash benefits with government-sourced canned goods, as well as tripling the rents for low-income Americans who live in subsidized housing projects. Moving SNAP out of the Agriculture Department would cut the agency’s budget by more than half.
The federal government administers more than 70 economic-assistance programs for people of limited means, including traditional cash welfare and various tax credits intended to ease the tax burden on low-income Americans. A patchwork of federal agencies administer the programs, and a wide range of congressional committees oversee them.
HHS is seen by conservative groups as having a better track record than Agriculture on welfare reform, having implemented broad Temporary Assistance for Needy Families work requirements in the 1990s during Bill Clinton’s presidency and, this year, fostering the Medicaid work requirements.
“HHS took this directive to heart and has been churning out some pretty great things in the last six months,” said Kristina Rasmussen, vice president of federal affairs at the conservative Foundation for Government Accountability.