President Bill Clinton’s landmark Workfare Act required welfare recipients to work as a prerequisite to a welfare check. It led to more Americans participating in the workforce and a remarkable reduction of the welfare rolls. Taxpayers and the recipients themselves benefited.
But the tight work requirements were loosened considerably in the Obama years, which was partially responsible for the huge increase in the number of people no longer in the work force (up to 40 million in the 25- 64 age bracket).
Now, the Trump Administration is formulating rules requiring work for Medicaid. It’s about time.
With all the debate over the health care bills in 2017, little attention was being focused on how the explosion of Medicaid can fundamentally change the basic underpinnings of American society.
The media gushes over how millions of Americans now get health insurance thanks to the expansion of Medicaid. What they fail to mention is that once you start getting your health care through Medicaid, rather than through an employer, you can be forever trapped in the mire of government dependency. And that means that you become more concerned about keeping your eligibility for Medicaid, and the healthcare it bestows, than upon advancing on a career path with promotions and higher wages, or even getting a job in the first place.
This is why it’s not good news that the number of covered individuals receiving health insurance from Medicaid, rather than through employers, was far more than what was predicted by the Congressional Budget Office.
This is not to say that the system in place pre-Obamacare was acceptable. Not when over 40 million people were uninsured and just a slip and fall away from financial calamity.
Something had to be done, and President Obama deserves credit for bringing the issue to the forefront. But the proposed solution was deeply flawed because it refused to touch the underlying factors pushing up costs, such as frivolous lawsuits, wasteful spending in the last six months of life, and the lack of accountability in the billing of consumers.
It also misunderstood the nature of insurance. Insurance works by having those who lead riskier lifestyles (i.e. smokers, heavy drinkers, bad drivers or acrobats) pay more than those who utilize the system less. This doesn’t mean we should trash provisions for pre-existing conditions, but perhaps younger, healthier folks don’t need a Cadillac insurance plan.
It was thought that taxpayer subsidies could iron out the incongruities, but even the massive injection of tax dollars – amounting to $110 billion annually – is still not enough to prevent the system’s collapse.
So, the push was made to just keep liberalizing the eligibility for Medicaid – a 100 percent pure taxpayer entitlement.
Medicaid is growing with such little resistance because no one is looking at the bottom line. You can find hundreds of articles about how many folks will be hurt by reforming Obamacare, but few about how much Medicaid expansion will increase the deficit due to the fact that much of the spending is not paid for.
Even Republican governors lobby for the expansion because they are getting free money from the Feds. While the states traditionally pay 50 percent of the Medicaid share, the Feds pick up 90 percent of the cost of anyone added to Medicaid under the Obama proposal. But someone has to pay for this. It will be our children and grandchildren as our federal debt reaches almost irreversible levels.
Obamacare has led to a one third increase in the number of New Yorkers, now 6 million, on Medicaid. That is one of every three residents.
Moreover, as President Clinton said in his criticism of Obamacare, how does that make people feel who are out there “bustin’ it” every day, rising at 5 a.m. to go to work?
When will someone finally focus on how this enhanced dependence on Medicaid will cost taxpayers dearly and will stagnate the lower class by making it infinitely more difficult to climb the social ladder, something that was once the hallmark of the America we once knew.
Steve Levy is Executive Director of the Center for Cost Effective Government. He served as Suffolk County Executive, as a NYS Assemblyman, and host of “The Steve Levy Radio Show.”