Joe Did What? Work as Punishment

Poster by Shephard Fairey, 2017.

 

One of the executive orders in that first extraordinary rush—is it three weeks ago now?—was to commission a review of the various Trump-era programs in various states for putting work requirements on Medicaid benefits, as if they thought not having a job in the cash economy was a kind of crime, and cutting off your access to a doctor was an appropriate punishment. Good thing! It was a terrible policy idea, not merely pointlessly cruel (these programs are meant to help out people who need help, not reward them for being virtuous) but also especially stupid, in that it's harmful to public health: one of the basic reasons for providing healthcare to those who can't afford it is to reduce the amount of disease to which everybody, rich and poor, is exposed.

The work requirements, a longstanding conservative goal, were a policy priority for Seema Verma, who ran the federal Medicaid program under President Trump. This was an about-face from the position of the Obama administration, which steadfastly opposed the idea of tethering public health benefits to work — something that had never happened in Medicaid’s nearly 60-year history. Obama administration officials repeatedly rejected states’ waiver requests, stating concerns that they “could undermine access” and that they did “not support the objectives of the Medicaid program.”

But Ms. Verma’s Medicaid agency encouraged states to apply, arguing that the policy could help lift poor Americans out of poverty by encouraging them to to find jobs. The requirement was to apply only to childless, nondisabled adults, a group she described as able-bodied.

In practice, the work requirements were barely enacted. Only one state — Arkansas — actually started such a program. Other state plans were either quickly halted by the courts, or placed on pause as state officials waited for litigation to play out. In Arkansas, about 18,000 adults lost health coverage because of their failure to document work hours, before a judge stopped the state from continuing the program. Evidence there suggested that few affected people knew the work requirement existed, and many who did struggled to complete the necessary paperwork.

What's really remarkable is what slid out of the Biden White House on Friday, practically unheralded, in the form of action; the review seems to be complete already, and states contemplating such programs were put on notice that approval is going to be withdrawn, and the Trump guidance inviting states to think about Medicaid work requirements has been rescinded. Just like that, no fuss at all, bad idea, out the door,

The whole idea of work requirements is still in the news, though, partly because of the huge Biden program, part of the Covid relief bill, for getting cash grants to parents regardless of employment status, through the tax system, $250 to $300 per child per month, the larger amount for kid under six, phasing out after a maximum income of $75,000 for a single parent or $150,000 for a couple, and which is thought likely to reduce child poverty in the United States by up to 50%. Then there's a rival proposal from Senator Willard Mitt Romney working through Social Security, upping the payment to $350 for the under-sixes (back to four months before due date for fetuses) for a couple earning a maximum of $400,000, and some very poison-pillish elements—most of the money ($200 billion) is shuffled over from the Earned Income Tax Credit, which is basically eliminated for people with children, so it really only adds $66 billion to the kitty, and the bulk of that is paid for by eliminating cash welfare (TANF) and the federal tax deduction for state and local taxes and, worst, taking away the ability of single earners taking care of children or elderly parents or other kinds of dependent to get a better tax rate by filing as a head of household, which looks like it's meant to punish adults for having dependents without being married. It does some of the most important things the Biden program does (replacing the EITC with these checks means they will go to the parents too poor to get any EITC, and their 27 million total children, and effectively recognizes that childcare is real work even if you don't get paid for it), but would do still more for those quite well-off parents (up to $400,000? really?) salting it away in the college fund and, as I'll keep saying, increasing the national wealth inequality on the deal.

Anyhow, these proposals, at least the Biden one, are rousing the usual moral hazard anxiety among the conservatives, and a really nice long piece from Ezra Klein (settling very comfortably into his New York Times gig) offers some valuable reaction ("'There's No Natural Dignity in Work'"): 

Even if a child allowance would lead some parents to drop out of the formal work force, would that be a bad thing? Forcing parents into low-wage, often exploitative, jobs by threatening them and their children with poverty may be counted as a success by some policymakers, but it’s a sign of a society that doesn’t value the most essential forms of labor. The problem lurks in the very language we use. If I left my job as a New York Times columnist to care, full time, for my 2-year-old son, I’d be described as leaving the labor force. But as much as I adore my child, there is absolutely no doubt I’d be working harder. I’d have fewer days off, a more demanding boss and worse pay.

“One of the bigger symbolic purposes of the child allowance is to say the work a parent does is valid — it’s valid as work,” Samuel Hammond, director of poverty and welfare policy at the Niskanen Center, said. “I do think it’s a market failure in capitalist economies that there isn’t a parenting wage.”

That's an important point. But more important is to question the whole assumption, that "work" is what endows the person with "dignity":

“People on the right always say, what about the dignity of work?” [Jamila Michener, co-director of Cornell’s Center for Health Equity] told me, “and my answer is: What about the dignity of dignity? The ability to be of sound body and mind and do the things most human beings want to do: spend time with your family. Have some time for leisure. Of course there can be dignity in work, and we should create the circumstances to make that possible, but there’s no natural dignity in work. We’ve needed labor movements because work can be harmful and oppressive unless we organize to make sure it has dignity. There are a lot of other factors and ways we need to intervene if we want work and dignity to be words we can use in the same sentence. And the way we do our social policy in this country, we have no right to use those words in the same sentence.”

Otherwise it's really just "Arbeit macht frei." I'm not even kidding.