Locking The Front Door

Glenn Koenen

On my way to bed I check the front door.  Each night I snap the long-throw deadbolt deep into the door frame – not to keep me, my wife or our 14 pound Jack Russell in but to keep the outside out.

On Thursday Seema Verma, head of the Centers for Medicare and Medicaid Services announced a new federal policy allowing states to impose work requirements for Medicaid [ https://www.washingtonpost.com/national/health-science/trump-administration-opens-door-to-let-states-impose-medicaid-work-requirements/2018/01/11/d6374482-f628-11e7-a9e3-ab18ce41436a_story.html?tid=a_mcntx&utm_term=.0d38449a319a ].  On Friday, Kentucky announced that it wanted permission to follow the new policy [ https://www.washingtonpost.com/national/health-science/kentucky-becomes-the-first-state-allowed-to-impose-medicaid-work-requirement/2018/01/12/b7b56e3e-f7b4-11e7-b34a-b85626af34ef_story.html?utm_term=.383581492c00 ].

Several other states indicated they want to impose Medicaid work requirements too.    It is probable that the Missouri Legislature will order this state to seek permission for ‘must work for medicine’ too.

That means that struggling adults in Missouri will soon face different (often substantially different) work requirements for MO HealthNet [Medicaid], SNAP [food stamps], and, Temporary Assistance.

Now, like most folks in the social service world, I have nothing against strongly encouraging those who can work to work.  Requiring people to work raises several issues…

❶  Work requirements assume that an abundance of fulltime or almost fulltime open positions exist.  That’s not true in most of Missouri or most of America.

❷  Work requirement rules never demand a living wage.  Many jobs pay so little they push people deeper into poverty.

❸  Work requirements turn Missouri’s Department of Social Services into a jobs program.  Despite decades of trying, DSS always fails miserably at job development.

❹  Verifying and tracking compliance with work requirements steals precious staff and money which could be used to help feed and care for struggling families.

Yes, Missouri and much of the country has the lowest unemployment rate experienced in decades.  Alas, not all boats are afloat.  In many areas job openings are hard to find, especially positions which don’t require work specific competencies (such as a Commercial Driver License to drive a delivery vehicle).  And, remember, no job opening counts towards a work requirement unless it offers 20 or 30 hours of guaranteed employment every week without fail!

Ohio spent a secret fortune to lure Amazon to the Buckeye state.  Still, “Amazon ranked nineteenth in the state [among large employers], with 1,430 employees in families receiving SNAP,” [ https://www.thedailybeast.com/study-more-than-one-in-ten-amazon-employees-in-ohio-are-on-food-stamps ].  That’s better than one in ten employees still needing government help to feed their families.  In rural Missouri where reports say that $8.00 an hour is about the average, well, taking a job 30 miles from home and paying part of the cost of child care may result in a net of $150 a week for the family.

A hollowed-out labor market
is partly to blame …

A fundamental refashioning of the labor market has been underway for two decades. Jobs that require middle-range skills have been declining, while those involving skills at both the lower and higher end of the spectrum have been growing. This effectively suppresses wages for many: People in lower-paid, lower-skill jobs — retail workers, janitors and home health aides — have little bargaining power to demand higher wages. Middle-skilled workers — including clerks, call center operators and factory workers — are being replaced by computers, robots and lesser-paid hands in low-wage countries. Higher-skilled workers are capturing an outsized share of pay.

[ https://www.nytimes.com/interactive/2017/10/07/business/wages-versus-unemployment.html ]

A generation ago Missouri launched the FUTURES program to move “welfare moms” into the work force.  Bottom line: it didn’t work.  Before that Missouri tried grant-based training programs for welfare adults, such as the one at Metroplex (now the CAASTLC) here in St. Louis County which gave young women months of training for the next big thing, Wang Writer word processing.

While the state is better than a year late producing the report on its current efforts to move parents in Temporary Assistance into jobs, that effort may be the greatest (and most expensive) failure yet!  Years into expensive contracts with agencies about the state, in November just one parent was in On the Job Training and fewer than 40 were in Education Related To Employment. [ https://dss.mo.gov/re/pdf/fsd_mhdmr/1711-family-support-mohealthnet-report.pdf ]  I asked a senior county-level state employee how many parents had been placed into jobs good enough for them to graduate from the program.  After hemming and hawing they admitted that they had no proof that even one family had escaped poverty due to the current state effort.

Oh yes, like most extra large bureaucracies, the Department of Social Services loses paperwork, incorrectly cancels benefits, miscalculates money, and frequently utilizes the headless chicken business model whereby staff are thrown at the crisis du jour.  (Last month DSS re-assigned Call Center staff to help move a pig-size load of Medicaid applications through the python due to the Affordable Care Act annual enrollment.)

So, let’s now assume that top Missouri and Washington bureaucrats have at least a fleeting relationship with reality.  They know work requirements sound good but seldom do good.  Why do they keep pushing more and more stringent work requirements?

Simple.  They know that a significant portion of those eligible for help won’t be able to comply with the work requirements or the associated paperwork.  Lock the door tight so eligible, struggling people get denied help.  That saves money.

A lot of money…

In Missouri if you prevent just 1,000 people from joining MO HealthNet the state could save $8.3 million in one year.  [October cost of $694.64 per recipient x 12 months x 1,000]  A thousand denied food stamps saves $1.4 million.

While saving money is the real motivation, the right’s mouthpieces cloud the issue with talk of self-worth and family preservation.  (The Heritage Foundation repeated that mantra is a report issued this month, https://www.heritage.org/node/1879502/print-display .)

Unfortunately, Verma with CMS spoke the truth this week…

Lastly Verma said, state Medicaid programs must be put on a budget to prevent costs from continuing to rise.  “We’ve seen these programs grow and grow and grow,” she said.  “We want to make sure we have a stable program over the long term and make sure there’s some type of a growth rate that we can all agree to.”

[ https://www.statnews.com/2017/10/26/seema-verma-medicaid-plan/ ]

Of course, Medicaid is growing because tens of millions of Americans (including at least 300,000 here in Missouri) lack any medical coverage.  Locking the door to keep them outside the system should not count as progress.  Yet, it will.

Submitted by Glenn Koenen, WCD Member