By Ben Pistora, Fellow for Public Witness
This spring, advocates must be aware of the potential risks to the health and wellbeing of economically marginalized Americans as Congress and the Administration shift their focus from taxes to the federal budget. One of the biggest threats we face is the establishment of work requirements on programs that provide basic access to a dignified life. Over recent decades, there have been numerous efforts in states to impose work requirements and lifetime limits on entitlement programs such as SNAP and Medicaid. We as Presbyterians must be vigilant to ensure further limitations do not become federal law.
To understand the dangers associated with work requirements, one must only turn to the SNAP (Supplemental Nutrition Assistance Program) requirements already in place. SNAP is a program administered through the USDA and was formerly known as “food stamps.” It provides critical nutritional assistance to working families and individuals whose conditions make it difficult to find work. SNAP is a highly effective program that targets households that need it to meet their basic food needs. With a small average benefit of just $1.40 per person per meal, it is by no means luxurious but it has demonstrated long-term benefits for children who participate, including better health and education outcomes. While SNAP’s overall enrollment and spending have dropped as the economy improves, it provides vital assistance to over 40 million low-income Americans.
Individuals designated as “Able-Bodies Adults without Dependents” (ABAWD’s), can only receive SNAP benefits for three month period over the course of three years if they fail to meet the work requirement. This poses an enormous problem for people who would like to work but live in an area where employment is scarce. Such requirements do not create jobs when jobs are hard to find and therefore put people who count on entitlement benefits as part of their monthly budget in a difficult and sometimes dangerous position.
The President’s budget proposal advances the idea of “Harvest Boxes,” as an alternative to SNAP. Seeking to cut roughly $21 Billion annually from SNAP, the administration proposes replacing SNAP with boxes of non-perishable items such as peanut butter and canned vegetables. The proposal is outlandish and generally thought to be a distraction from the proposed cuts. We must remain focused on the proposed $213 billion dollar cut over the next 10 years.
The administration is now also seriously considering allowing states to impose lifetime limits for Medicaid. Such a move would involve time-based caps on Medicaid participation similar to those currently seen with the TANF (Temporary Assistance for Needy Families) so that recipients would see their health care coverage run out in the midst of a medical emergency or a chronic illness. This poses a grave threat to all 68,000,000 Americans who receive life saving health coverage from Medicaid.
The 1976 PCUS Statement reminds us that, “The value of life gives persons the derivative right to acquire the therapy or care [needed] that they might enjoy the quality of life health makes possible… Because the right to acquire “adequate” health care springs out of our worth as living human beings, rather than out of any particular merit or achievement belonging to some but not to others, adequate health care should be defined equally for all people.” The 217th General Assembly reaffirmed the crucial role of Medicaid, calling upon Congress and the White House to, “preserve the Medicaid program as a safety-net for those who are economically vulnerable who require assistance to purchase long-term care, and to strongly limit the ability of states to obtain waivers that reduce the population eligible for Medicaid supported services.” It is fundamentally unacceptable for the administration to allow states to adopt such immoral limitations.
Since the 1960’s, Medicaid has helped to provide health care to millions of low-income Americans and people with disabilities who simply cannot sustain a dignified life under the burden of high medical costs. Medicaid came into being alongside Medicare in 1966 as part of President Johnson’s “Great Society” policy platform. Responding to national issues of poverty and ever increasing health care costs, Medicaid sought to address the need through an entitlement program that would include a broader population that Medicare. Over half a century, the program has served as a backbone of the social safety net, carrying hundreds of millions through hardship.
There have never been lifetime caps imposed on the program, but five states (Arizona, Kansas, Utah , Maine, and Wisconsin) are requesting that President Trump provide federal waivers that might cap Medicaid. Such a move would disregard the reality that Medicaid has proven among the most efficient programs in American health insurance. For these states to follow the White House’s lead and cut accessibility to the program could only have terribly disastrous consequences. Medicaid is a core and fundamentally moral commitment to human wellbeing of which there should be no limitation.
The 2017 Faithful Budget, the cumulative product of dozens of faith organizations answering the call to combat poverty, asserts the critical effectiveness of the program and the moral obligation, “to adequately fund human needs.” It is not and never has been a simple question of money, but rather has been driven by the most core human and moral values.
To Learn more about work requirements in public programs, consult this Bread for the World Fact Sheet.