THREE OF the federal government’s largest means-tested safety-net programs are Medicaid, the Supplemental Nutrition Assistance Program (SNAP) and housing assistance. To list these is to list the conditions against which Congress has decided to protect those who do not have enough money to protect themselves: sickness, hunger and homelessness. The Trump administration, with the support of the Republican Congress, seeks to make these protections more contingent than they are at present on the beneficiaries’ work effort. A new report by the White House Council of Economic Advisers argues for work requirements in noncash federal safety nets akin to those enacted for cash assistance in the 1990s, on the ground that “self-sufficiency has fallen in recent decades while material hardship has fallen.”
How much sense does this make, given the risk that those who now use these programs and fail to meet a work requirement will still need medical care, food and shelter? The answer: not much. With respect to Medicaid, the largest of the three means-tested programs, the Kaiser Family Foundation estimated that 62 percent of working-age adults enrolled work full or part time; some 18 percent live with a working adult. The White House report found somewhat lower rates using older but, it says, more precise data.
Whoever’s right about that nuance, the essential problem remains: There is no connection, actuarially, between work and the need for health insurance. Universal coverage, the goal of the Affordable Care Act — which Republicans are still trying to dismantle — is far more efficient overall than attempting to cobble together a plan that links eligibility to work effort. Assuming there is a work requirement, and Medicaid-eligible people lose coverage — some 7,000 people in Arkansas failed to meet a new requirement the state had enacted in its first month, though those people have not yet lost coverage — they will still seek treatment. And it will still be at public expense, in hospital emergency rooms.
A similar analysis applies to SNAP, where the White House report notes that 18.6 million of the 47.6 million recipients in 2013 were non-disabled working-age adults. Importantly, SNAP rolls have already fallen by more than 5 million as of 2017, because of a surge in employment — a reminder that the business cycle has a big impact on overall SNAP program size and cost, probably bigger than the work incentives it creates. In any case, many of those who do not work have minor children at home, which means the reasons for their not working may include a lack of child-care options. Any humane work requirement would have to address that issue, which costs a lot of money, as would training and other support. The work requirement for SNAP included in a House version of the most recent farm bill would underfund those needs.
Safety-net programs should be designed so as not to create disincentives to work. But means-tested programs are, at most, a minor cause of lagging labor-force participation. In fact, Republicans appear to be fighting the last war, because workers are returning to the labor force, drawn by full employment and the better wages it brings. Tight labor markets are what they should be trying to perpetuate, not stereotypes about the undeserving poor.