Work Requirements Will Help, Not Harm, Medicaid Recipients
The recent announcement by the Trump administration that states can seek waivers that require able-bodied adults on Medicaid to work, train, or volunteer is good news not just for federal and state budgets, but also for Medicaid recipients themselves.
One principle underlying the Centers for Medicare and Medicaid Services’ new guidance to allow states to adopt commonsense work requirements is that work and community engagement can improve both physical and mental health. And that principle, in turn, relies on sound science. Indeed, there is abundant evidence that regular work improves health. Unemployment, by contrast, can seriously weaken physical and mental health. If common sense is not enough to show that link, numerous studies have demonstrated those conclusions.
One systematic review found “strong evidence that unemployment is harmful to health,” including higher mortality rates, worsening general health, and poorer mental health. Moreover, the study found that “there is strong evidence that re-employment leads to improved self-esteem, improved general health, and reduced psychological distress.” Work can be therapeutic for those who are sick or disabled, and “promotes full participation in society, independence and human rights.” The study concluded that “work is generally good for health and well-being.”
Two other scholars analyzed 16 different studies of the relationship between unemployment and mental health; most showed a positive impact moving from unemployment to employment. In another study, loss of employment among middle-aged workers was associated with a higher risk of mortality. Long-term joblessness is correlated not only with lower earnings in later life, but also with higher mortality. And in Scandinavia, researchers reached similar results on the negative effects of unemployment.
According to the Foundation for Government Accountability, there are nearly 28 million able-bodied adults currently enrolled in Medicaid. Research shows that getting these Americans into work will not only relieve pressure on stressed budgets but will also help improve their own health status.
And the need for reform is urgent. In New Hampshire — one of the states already seeking Medicaid work requirements — 58 percent of able-bodied adults on Medicaid have no earned income. Under the new rules, these individuals will have a chance to improve their health through work, job training, or volunteer opportunities that reconnect them with their communities. These are all activities that benefit both the individuals themselves and society as a whole.
The evidence on the power of work is clear and robust. Work improves physical and mental health, providing purpose and dignity that no plastic welfare card could ever replace.
The administration’s decision also brings Medicaid policy in line with that of other welfare programs. Just as President Clinton and a Republican Congress reformed cash welfare to require work back in the 1990s, the Trump administration is embracing the principle that able-bodied adults on welfare programs — including Medicaid — should work, train, or volunteer. Thus the Trump administration’s guidance is neither unfounded nor unprecedented. Like earlier reforms, it’s based on clear and convincing scientific evidence and a desire to improve the health and financial situations of welfare recipients.
It is therefore surprising that the administration’s guidance has proved so controversial. Rather than reject this new Medicaid policy out of hand, we should welcome it as a good first step towards bringing the benefits of work to more Americans and reforming the program to concentrate on those most in need.
Dr. Richard Sugden is a family medicine doctor in Jackson, Wyoming.