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work requirements
Georgia Medicaid Debacle Bolsters Progressive Case Against Work Requirements
"While state politicians continue playing games with people's lives, Georgians are dying because they can't afford the healthcare they need," said Sen. Raphael Warnock.
Dec 26, 2023
An effort by the Republican-led Georgia government to partially expand Medicaid is falling well short of enrollment expectations, a failure that could stem from the program's burdensome work requirements and other administrative barriers that are abundant in a for-profit system that doesn't guarantee healthcare to all as a right.
Politico reported Tuesday that just 1,800 people enrolled during the program's first four months—leaving the state on pace to miss Republican Gov. Brian Kemp's target of 31,000 enrollees within the first year.
"Critics blame the paltry expansion on an overly complex program with too many hurdles for people to clear," the outlet noted.
Brendan Duke, senior director for economic policy at the Center for American Progress, wrote in response to Politico's reporting that "a large part of progressive opposition to work requirements in safety net programs isn’t principle—it's about the paperwork that prevents working people from enrolling in programs they qualify for."
"Great example with Georgia and Medicaid here," Duke added. "Work requirement supporters will ask, 'Why do you oppose work reqs if the vast majority of people would still qualify?' Some of the problem is you're denying support to people who can't find a job. But some of it is you're functionally denying support to people with a job!"
As Georgia began rolling out its Pathways to Coverage program earlier this year following a legal fight with the Biden administration, researchers at Georgetown University's Center for Children and Families (CCF) argued that the state's insistence on a work requirement would likely box many people out, including workers with irregular hours and parents who lack access to childcare.
The work requirements in Georgia's program do not include an exemption for caregiving or high childcare costs, the CCF experts noted. As such, they warned, "many parents will likely remain uninsured under the Pathways program especially parents of babies and toddlers who are preschool age."
Georgia, which has one of the highest uninsured rates in the U.S., is currently the only state with a Medicaid work requirement in effect—though it's not the first to ever implement one.
In 2018, with the approval of the Trump administration, Arkansas put in place work mandates for Medicaid with disastrous results. Before the policy was blocked in federal court, more than 18,000 people in the state were thrown off Medicaid in just seven months for failing to adhere to the requirements.
The Arkansas policy did not boost employment, an outcome consistent with research showing that work requirements are only effective at stripping people of benefits.
"Pathways to Coverage has cost Georgia more money and covers far fewer people than if the state simply joined 40 other states in expanding Medicaid."
In 2021, the Biden administration rescinded Trump-approved waivers that had allowed Georgia and other states to add work requirements to their Medicaid programs. Georgia challenged the decision in court and prevailed last year, thanks to its argument that the experiment would lead to more people receiving coverage than if the program were blocked.
Kemp has suggested that around 345,000 Georgians could be eligible for the expanded Medicaid program, but the state expects that just around 64,000 will eventually enroll in the program.
That's just 14% of the people who would be covered if Georgia joined nearly every other U.S. state in fully expanding Medicaid under the Affordable Care Act, CCF researchers estimated earlier this year.
In addition to covering fewer people than full Medicaid expansion, Georgia's experiment is also expected to cost the state far more.
Leah Chan, senior health analyst at the Georgia Budget and Policy Institute, told a local Georgia newspaper earlier this year that Pathways to Coverage will cost roughly $2,420 per enrollee. Full Medicaid expansion, by contrast, would run the state just $496 per enrollee, as the federal government pays much of the cost.
Sen. Raphael Warnock (D-Ga.) told Politico that "Pathways to Coverage has cost Georgia more money and covers far fewer people than if the state simply joined 40 other states in expanding Medicaid."
"While state politicians continue playing games with people's lives," he added, "Georgians are dying because they can't afford the healthcare they need."
Heightened scrutiny of Georgia's Medicaid experiment comes as states across the U.S. are rapidly conducting eligibility checks and kicking people off Medicaid en masse following the end of pandemic-era protections. Georgia is one of nine Republican-led states that collectively account for 60% of Medicaid and Children's Health Insurance Program disenrollments this year.
An overwhelming majority of the disenrollments nationwide have been for procedural reasons, such as a paperwork error.
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Food Stamp Work Rules Harm Older Poor Americans
The new restrictions “put almost 750,000 older adults aged 50-54 at risk of losing food assistance,” the Center for Budget and Policy Priorities Found.
Sep 13, 2023
Life is getting even tougher for poor people in America. As poverty rates soar—due in part to policies such as cutting pandemic aid for poor and working-class people—new rules that kicked in September 1 only add to the suffering.
As if being poor and unable to afford food isn’t hard enough, new food stamps rules require all destitute Americans up to age 50 to work 80 hours a month for their monthly aid, under the Supplemental Nutrition Assistance Program (SNAP). Next year this will extend to 54year-olds.
Disturbingly, Republicans originally sought to impose work requirements on all recipients up to age 65, forcing older poor people to toil for their meager food assistance.
The new restrictions “put almost 750,000 older adults aged 50-54 at risk of losing food assistance,” according to the Center for Budget and Policy Priorities (CBPP), worsening hunger and poverty for older Americans.
“Meeting basic life-sustaining needs should not be contingent on meeting a work requirement.”
Already, elder poverty and hunger are severe and widespread. According to U.S. Census data, some 16.5 million Americans over age 65—nearly one in three—are living at or below 200% of the federal poverty level. This includes more women than men, and more than half of Black and Hispanic Americans over age 65, the National Council on Aging reports.
Working after age 50 is precarious. Most workers ages 51-64 do not have continuous employment. Meanwhile, the US economy's fastest-growing occupations, such as home health and personal care work, have 14% of older workers claiming food stamps to make ends meet.
As the CBPP explains, most SNAP recipients are already working, between jobs, or are “providing unpaid care” for children or other family members.
Research shows the new work rules are likely to diminish SNAP participation for older Americans. A 2023 study published by the American Economic Association found that “Overall program participation among adults who are subject to work requirements is reduced by 53 percent.” CBPP reports that, “Growing evidence shows that these SNAP requirements increase hardship.”
Putting the Poor and Seniors at Risk
Even before the new rules, according to the Food Research & Action Center (FRAC), “Millions of older adults who struggle against hunger are missing out on a critical program to help put food on the table”—with three in five eligible older adults losing out on SNAP benefits each month. According to the AARP, “an estimated 16 million (or 63 percent of) adults ages 50 and older who were eligible for SNAP did not participate in 2018.”
The new rules, the AARP wrote, “could worsen these barriers, increasing the risk that many older adults would not receive the SNAP benefits they are eligible for.”
Those benefits, while meager compared to people’s needs, provide low-income Americans with a critical economic and nutritional lifeline. Extensive research shows that “SNAP improves the health, nutrition, and budgets of vulnerable seniors,” according to Emily Allen of AARP.
Without this lifeline, older Americans who are denied food stamps “may be at increased risk of hunger and hunger-related health problems, such as diabetes, hypertension, and depression,” according to FRAC. “Food-insecure seniors often must choose between paying for food or medication,” according to Jim Weill, president of FRAC. SNAP, he notes, “helps ensure that seniors do not have to cut back on or skip meals altogether to pay for health care or other basic needs.”
Pushing Older Poor People to Work Longer
By design, the work-for-food policy pressures older folks back into the labor force. As harmful as the new restrictions are, they could get worse. Prior to the debt ceiling agreement, South Dakota Rep. Dusty Johnson proposed the America Works Act of 2023, seeking to extend work-for-food rules to age 65.
Johnson projected his own privileged situation onto other aging Americans: “As I approach 49 years old, I know I still have decades left of work ahead of me. My bill changes the maximum age rate… to be 65 years old, consistent with retirement and Medicare age.”
The parallels with efforts to cut Social Security are clear—both moves aim to coerce people to work longer into old age, and to reduce public benefits. The same lawmakers working to slash Social Security by pushing qualifying ages to 67 are seeking work requirements on poor seniors up to age 65.
States can ameliorate this expanded punishment of poor people by automatically enrolling Medicaid recipients in SNAP, as CBPP recommends. The state of New York’s Nutrition Improvement Project, for instance, automatically enrolls recipients of Supplemental Security Income who live alone into SNAP; and enables recipients to use their Medicaid benefit cards to access food stamps. A report found that by using data matching technology, state agencies can greatly expand access to benefits among older qualified poor people, leading to billions of dollars of assistance and local economic stimulus.
Working in old age can be engaging and rewarding, when it’s by choice rather than desperation or coercion. But as a 2022 Older Workers and Retirement Chartbook revealed, “Older workers who cannot afford to retire often face diminishing job quality and earnings as a result of loss of bargaining power.” Policies like the new SNAP work requirements coerce low-income Americans into work at older ages based on their economic desperation. It’s a harmful move that will only make life and survival harder for older poor people.Keep ReadingShow Less
Here Are the Progressives Who Voted Against the GOP's Debt Ceiling 'Extortion Scheme'
“We cannot continue to capitulate to a far-right Republican Party and their extreme demands while they inflict policy violence on working-class people, gut our bedrock environmental protections, and decimate our planet," said Rep. Rashida Tlaib.
Jun 01, 2023
Nearly 40 members of the Congressional Progressive Caucus broke with the majority of their House Democratic colleagues late Wednesday to vote against the debt ceiling agreement negotiated by President Joe Biden and Republican leaders.
The legislation, which would lift the debt ceiling until January 2025 and enact painful caps on non-military federal spending, passed the GOP-controlled House by a vote of 314 to 117, with 165 Democrats joining 149 Republicans in supporting the measure.
The bill's passage came after weeks of talks between the White House—which repeatedly said it would not negotiate over the debt ceiling—and Republicans who manufactured the standoff to pursue austerity for low-income Americans, gifts for rich tax cheats, and handouts to the fossil fuel industry.
While Republicans didn't get anything close to what they called for in legislation they passed in late April, progressives who voted against the bill on Wednesday said the final agreement will harm vulnerable people and the planet by imposing new work requirements on aid recipients and approving the Mountain Valley Pipeline—a top priority of fossil fuel industry ally Sen. Joe Manchin (D-W.Va.).
Progressives also raised alarm over a provision that would codify the end of the student loan payment pause, setting the stage for a disaster if the U.S. Supreme Court strikes down the Biden administration's debt cancellation plan.
"I cannot vote for a bill that guts key environmental protections and greenlights dirty fossil fuel projects for corporate polluters who are poisoning our communities, pushes our residents deeper into poverty by implementing cruel and ineffective work requirements for our low-income neighbors who rely on SNAP and TANF for food and housing, terminates the student loan payment pause, and slashes IRS funding to make it easier for the rich to cheat on their taxes," Rep. Rashida Tlaib (D-Mich.) said in a statement.
"We cannot continue to capitulate to a far-right Republican Party and their extreme demands while they inflict policy violence on working-class people, gut our bedrock environmental protections, and decimate our planet," Tlaib added, referring to the bill's work requirements for food aid.
In total, 38 members of the Congressional Progressive Caucus (CPC) voted against the legislation:
Reps. Tlaib, Pramila Jayapal (D-Wash.)
Katie Porter (D-Calif.)
Cori Bush (D-Mo.)
Alexandria Ocasio-Cortez (D-N.Y.)
Mark Pocan (D-Wis.)
Summer Lee (D-Pa.)
Greg Casar (D-Texas)
Rosa DeLauro (D-Conn.)
Jim McGovern (D-Mass.)
Barbara Lee (D-Calif.)
Dan Goldman (D-N.Y.)
Jimmy Gomez (D-Calif.)
Nanette Barragán (D-Calif.)
Jamaal Bowman (D-N.Y.)
Jan Schakowsky (D-Ill.)
Ro Khanna, (D-Calif.)
Chuy García (D-(Ill.)
Delia Ramirez (D-Ill.)
Frederica Wilson (D-Fla.)
Raúl Grijalva (D-Ariz.)
Jared Huffman (D-Calif.)
Sydney Kamlager-Dove (D-Calif.)
Gwen Moore (D-Wis.)
Grace Meng (D-N.Y.)
Ayanna Pressley (D-Mass.)
Jerry Nadler (D-N.Y.)
Melanie Stansbury (D-N.M.)
Val Hoyle (D-Ore.)
Juan Vargas (D-Calif.)
Nikema Williams (D-Ga.)
Sylvia Garcia (D-Texas)
Adriano Espaillat (D-N.Y.)
Mark DeSaulnier (D-Calif.)
Jasmine Crockett (D-Texas)
Yvette Clarke (D-N.Y.)
Judy Chu (D-Calif.)
Suzanne Bonamici (D-Ore.).
But the CPC members who joined Republicans in voting yes on the bill, including prominent progressive Rep. Ilhan Omar (D-Minn.), outnumbered those who opposed it.
Jayapal, the CPC chair, said Wednesday that she could not in good conscience be part of the Republican Party's "extortion scheme" by voting for legislation that "rips food assistance away from poor people and disproportionately Black and brown women, pushes forward pro-corporate permitting policies and a pipeline in direct violation of the community's input, and claws back nearly 25% of the funding Democrats allocated for the IRS to go after wealthy tax cheats."
Bush, who represents St. Louis, added that "this agreement, whose worst elements are undoubtedly the fault of MAGA Republicans who shamefully took our economy hostage, pairs raising the debt limit with many policies that will harm our most vulnerable communities."
"I am disgusted with the chief hostage taker Kevin McCarthy and his MAGA insurrectionist conference for threatening economic catastrophe," said the Missouri Democrat. "For the good of our country, and to prevent the GOP from politicizing the debt ceiling to harm our communities moving forward, I believe we must eliminate the debt ceiling altogether."
The bill now heads to the Senate, where lawmakers are expected to act before the June 5 debt-limit deadline set by the Treasury Department.
Sen. Bernie Sanders (I-Vt.), the lone Senate member of the CPC, announced ahead of Wednesday's House vote that he will oppose the legislation, calling it "a bill that takes vital nutrition assistance away from women, infants, children, and seniors while refusing to ask billionaires who have never had it so good to pay a penny more in taxes."
According to the Center on Budget and Policy Priorities, the measure's new work requirements for Supplemental Nutrition Assistance Program recipients would put nearly 750,000 low-income adults between the ages of 50 and 54 at risk of losing food aid.
"The fact of the matter is that this bill is totally unnecessary," Sanders said. "The president has the authority and the ability to eliminate the debt ceiling today by invoking the 14th Amendment. I look forward to the day when he exercises this authority and puts an end, once and for all, to the outrageous actions of the extreme right-wing to hold our entire economy hostage in order to get what they want."
This story has been corrected to include Reps. Katie Porter (D-Calif.) and Ro Khanna (D-Calif.) on the list of no votes.
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