Medicaid Workfare: Ideological Cruelty Masquerading as Good Public Policy

The President’s Cruel Workfare Guidance on Medicaid

When I was first released from prison I had no job and was mired deeply in criminal justice debt (the fines and fees judges add to sentences in the attempt to recoup court, supervision, and monitoring costs).

I tried to hit the ground running.

A friend had promised me a job when I was released and had even been nice enough to write a letter to the parole board stipulating that he was looking forward to hiring me when I was released (I am still very thankful he wrote that letter for me).

Unfortunately, his wife found out he was planning on hiring me and told him, in no uncertain terms that he could not hire me if he wanted to stay married to her.

Bad luck, but no problem, these things happen. I figured I was still going to be fine because I had 20 years of work experience, had raised millions of dollars in my work prior to incarceration, and I had an advanced degree.

So, I hit the street hard.

After two weeks of searching, I came to the conclusion I could not get a job doing anything but flipping burgers (or, maybe, stocking shelves).

Don’t get me wrong, I am not too proud to do either job (I cleaned prison bathrooms twice a day for two of my three years in prison). But, it seemed very unlikely I could pay off my debt, and make enough money to feed and house myself, as a nearly 50-year-old part-time fast food employee.

I decided to start a freelance writing business instead, but, as I was starting that business up, I had very few clients and almost no money…So, I applied for food stamps and the Medicaid expansion.

I know we have all heard the stories of the idle poor enjoying the good life while lazily reclining near the pool with mixed-drinks and platters of lobster all thanks to the largesse of the American Tax Payer but those stories are bullshit and being poor is really awful.

You probably have noticed that as angry as GOP representatives seem to get about the social safety net, no rich people volunteer to change places with poor people so that they can take advantage of those really amazing benefit programs.

One of the many shocking things I learned during my food stamp experience is that it is a “workfare” system (a system that requires that you work in order to receive benefits).

At the time I was frustrated to find that out (single men get an incredibly small stipend in the first place) but figured it would be no problem because I was easily working 80 hours a week trying to set up my business.


These workfare schemes force you to document the hours you work with paystubs. So, as a self-employed freelancer who was just starting up, I had very few clients and was being told that my sweat equity wouldn’t count towards getting my $17 a month in food benefits.

In lieu of magically creating more clients, I could choose either to forgo food stamps or get a job that paid by the hour and give up precious hours that I was using to start my business (I ultimately decided to forgo food stamps).

My point is that workfare requirements discourage entrepreneurship and tend towards locking people in poverty. On top of that, they are paternalistic and offensive.

<If the point weren’t paternalism and locking people in poverty wouldn’t these laws would include a mandatory increase in the minimum wage so that people working at low-end jobs had a living wage?>

It is true that sometimes, benefits can be more “lucrative” than a part-time job, but that speaks more to the kind of jobs workfare requirements lock-people into than it does about the inherent desire for poor people to work (“lucrative” by only the most cruel metric possible).

Someone reading this might be saying “GOOD,” but workfare is not good…and the available research demonstrates that it is not good:

Also, Food stamps are a net positive for our economy, there is no such thing as welfare queens, and poverty in America is awful to experience. As Wes Moore of the Robin Hood foundation put it:

Poverty is a horrible, bedeviling force that invades and infects every aspect of our lives and communities — our homes, our pantries, our schools, our careers, and our health. More than a half century ago, President Lyndon B. Johnson called for exactly the level of effort it will take to end the plague of poverty in the United States — “an unconditional war on poverty.”

Living on benefits is tough, living without benefits is even harder.

So what does all of this have to do with Medicaid?

President Trump’s New Workfare Guidance For Medicaid Recipients.

The above is the euphemistically titled guidance the Trump Administration released about Medicaid today.

In short, the Federal Government used to be a barrier to State experimentation with workfare under Medicaid but now, under President Trump, they are encouraging States to experiment.

In other words, within certain guidelines, the Executive branch of the Federal Government is encouraging states to enact workfare requirements into their Medicaid schemes.

And yes, the Guidance document encourages States to use tie their food stamp requirements to their Medicaid requirements (see, it all works together):

“CMS supports states’ efforts to align SNAP or TANF work or work-related requirements with the Medicaid program as part of a demonstration authorized under section 1115 of the Act, where such alignment is appropriate and consistent with the ultimate objective of improving health and well-being for Medicaid beneficiaries.”

I think that introducing this guidance was a terrible idea.

First, it was a “solution” searching for a problem that didn’t exist, all of the available evidence suggests that Medicaid recipients work or are physically (or mentally) unable to work. Here is a study to that effect released this week in my home state of Michigan:

And Medicaid, far from being a drain on State economies has actually been a boon (generating far more in economic benefit than cost):

And lets not pretend work requirements are an effective way of ensuring better social or economic outcomes, research has demonstrated conclusively that they are not:

In addition, I am horrified that we are trying to decide who morally qualifies for access to food and healthcare. No people should have to qualify to be considered worthy of eating when they are hungry or seeing a doctor when sick.

I can say unequivocally that the Medicaid expansion saved my life, there is no way I could have afforded to have a necessary recent surgery if I had not had access to Medicaid (it would have been a routine but necessary surgery for anyone with normal insurance).

And what would have happened if I had not gotten that surgery? Or worse, what if I had gotten that surgery in an emergency room (both increasing my unserviceable debt and creating an even larger penalty for everyone who pays into the health care system)?

You have to ask yourself why one political party in the United States so committed to:

Stripping health care and food benefits?

Destroying the social safety net?

Regressive taxation?

Embracing income inequality?

My Father is a life-long Republican, but this certainly is no longer the party he represents, today’s GOP is a party of cruelty, not compassion. I myself have supported Republican candidates in my life (when they were superior).

I believe that It has become a moral obligation to oppose today’s new GOP.

Even if you lean Republican, I beg you to read the articles above and reconsider your allegiance (not because the Democrats have great candidates or amazing answers but because what the GOP is doing is immoral).

For those of you who share my Christian Faith (and for those who don’t, I am not intending to proselytize), it should come down to this (Matthew 25:34–40):

For I was hungry and you gave me something to eat, I was thirsty and you gave me something to drink, I was a stranger and you invited me in, 36I needed clothes and you clothed me, I was sick and you looked after me, I was in prison and you came to visit me.’ 37“Then the righteous will answer him, ‘Lord, when did we see you hungry and feed you, or thirsty and give you something to drink? 38When did we see you a stranger and invite you in, or needing clothes and clothe you? 39When did we see you sick or in prison and go to visit you?’40“The King will reply, ‘Truly I tell you, whatever you did for one of the least of these brothers and sisters of mine, you did for me.’

Thanks for reading.

Josh is a blogger and freelance writer. Please consider following him on Twitter, throwing a tip into his hat on Patreon, show your appreciation using, or adding OnPirateSatellite to your feeds.



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Josh H

Author, Criminal Justice Reform Advocate, Co-Host of the "Decarceration Nation" Podcast, Television critic and Movie Reviewer,