Tag Archives: work requirements

Indiana–Ignoring Law, Pursing Bad Policy

Public Policy and Governance, ,

The current push by the Trump Administration to add work requirements to Medicaid is stupid and unworkable–not that Trump understands or cares. It is also likely to be costly–adding another condition to receipt of health care is yet another bureaucratic task, another box to be checked off by someone who must be paid to do the checking.

People knowledgable about the program point out that virtually all Medicaid recipients fall into one of three categories. They are elderly, disabled or children. (This is an administration that doesn’t listen to experts, of course. The President’s “gut” is the basis of policy, not evidence or fact.) The consensus of opinion from experts is that it would cost far more to administer the requirement than it would save by throwing a very few people off the program (unless, of course, the requirement is applied more broadly than justified).

And that brings me to my own State of Indiana, where ideology consistently defeats both facts and common sense. Indiana is continuing to pursue work requirements despite the overwhelming evidence that it’s a stupid policy and despite the fact that recent federal court decisions hold that it violates federal law.

On Wednesday, a judge struck down Arkansas and Kentucky’s Medicaid work requirement programs, throwing the future of the conservative health policy — and Medicaid expansion at large — into question.

U.S. District Judge James Boasberg’s ruling blocks Kentucky from implementing its program — which was the first approved by the Trump administration in January 2018 — and puts an end to Arkansas’ program, which has been running since June and has led to the loss of health care for tens of thousands of people.

In a case expected to reach the U.S. Supreme Court, Judge Boasberg ruled that “Medicaid is an entitlement” and that the defendants “did not address … how the project would implicate the ‘core’ objective of Medicaid: the provision of medical coverage to the needy.”

A number of Republicans echo the position taken by (increasingly unpopular) Kentucky Governor Matt Bevin. Bevin has vowed to end Kentucky’s entire Medicaid expansion program if he can’t implement the work requirements. That  would mean 400,000 people would lose their health insurance–but punitive ideology is clearly more important to Bevin than the health care of 400,000 citizens of his state.

Gives “my way or the highway” a whole new emphasis….

What makes this position especially egregious is that it isn’t prompted by cost concerns; it is entirely motivated by opposition to government-provided health care even when the federal government is paying for it.

Work requirements for Medicaid, the nation’s health insurance for the poor, sprang up after the passage of the Affordable Care Act, President Barack Obama’s signature legislation. The law allows and helps states offer Medicaid to more low-income people. The federal government initially pays 100 percent — and eventually 90 percent — of the costs of expanding eligibility to people earning 138 percent of the federal poverty line.

Most of the early adopters of Medicaid expansion were Democratic-led states. Some Republican-led states have slowly expanded coverage, but most of them have added a work requirement for nondisabled people — a policy that the Obama administration repeatedly rejected. Under the Trump administration, CMS has approved work requirement waivers for Arkansas, Arizona, Indiana, Kentucky, Michigan, New Hampshire, Ohio and Wisconsin.

I will never understand the Republican animus toward the poor. Whatever happened to the Christian admonition about caring for “the least of us”?

 

Watch Your Language

Random Blogging, , ,

I think it was Tallyrand who said “speech was given to man to conceal his thoughts.” Political spinmeisters, advertising executives and faux scholars are proving him prescient; they have perfected the use of language to label and deceive, rather than communicate.

The following paragraph is typical (no link, as I have forgotten where I got it):

The Sanders-led progressive movement has successfully tugged the party to the left, bringing ideas that seemed fringe in 2016 to the center of the mainstream Democratic agenda. Many of the party’s presidential hopefuls now embrace some of the biggest planks of the Sanders platform, from Medicare for All to legalizing marijuana to rejecting corporate donations.

A genuine Leftist–vanishingly rare in the U.S.–would laugh at the suggestion that universal health care (once proposed by Richard Nixon), sane drug policies based upon sound medical research, and campaign finance reform (championed by John McCain) are somehow “far Left.” But that’s the state of political discourse in America these days, where ideology and animus trump both evidence and the careful use of language.

Peter the Citizen, an expert on social welfare programs to whom I’ve previously cited, recently sent me a good example of the way it works. (Peter is hardly a bleeding heart liberal–he worked in the Reagan White House. He just believes that research projects should be designed to find answers to questions, not manipulated in order to confirm pre-existing biases.) The issue was whether recipients of certain social programs should be required to work in order to qualify for benefits.

He wrote:”I believe work requirements can be a useful policy tool, but they must be reasonable, realistic, and based on sound evidence.  Too much of the debate today ignores these factors and is based on misreading the credible evidence that exists (i.e., the random assignment experiments of welfare-to-work programs) or, even worse, relies on studies with fundamentally flawed methods.

“How effective are work requirements?,” a paper by Angela Rachidi and Robert Doar of the American Enterprise Institute, came in for special scorn. The authors purport to find evidence that “largely supports” extending work requirements to non-cash programs like SNAP  and Medicaid, and they argue that critics of work requirements have “misread” and “misrepresented” this research.

As Peter notes,

It turns out that it is Angela and Robert who have misread the evidence.  They mischaracterize the arguments of “critics” of work requirements, misinterpret the results of random assignment experiments, and then over-generalize from a limited number of demonstration projects to make claims about work requirement proposals that would operate on a much larger scale, for different programs and populations, and with different levels of funding.

Peter’s paper critiquing this “research,” can be found here.

Peter also referenced an article titled “They’re the think tank pushing for welfare work requirements. Republicans say they’re experts. Economists call it ‘junk science,’” by Caitlin Dewey of The Washington Post. In the article, Dewey described the newfound influence of a think-tank named Foundation for Government Accountability (FGA) (given the name–the label– I assume its an offshoot of that well-known organization “Grandmas and Kittens for Good Government.”)

But hey–they are saying what Paul Ryan and the Koch Brothers want to hear, so they must be legit, right?

House Republicans – including [Speaker] Ryan, who was introduced to the group in 2016 through Kansas Gov. Sam Brownback – have repeatedly proffered the FGA’s analysis as proof that most Americans support strict work rules in welfare programs and that such rules boost income and employment.

While the FGA’s “studies” have support among some politicians, their work is not seen as credible by serious observers.  To understand why, it is informative to compare their methodological approach for making claims about the impacts of work requirements (and other welfare reform policies) with generally accepted criteria for assessing the soundness of an evaluation.

In 1997, Peter co-authored a monograph with Doug Besharov and Peter Rossi – Evaluating Welfare Reform: A Guide for Scholars and Practitioners – which described and explained those “generally accepted criteria.”  Peter applied the criteria the to the FGA’s “research,”  and developed the following “report card”: “How Do the Foundation for Government Accountability’s Evaluations of Welfare Reform Measure Up? A Report Card (Hint: The FGA Fails)”: https://mlwiseman.com/wp-content/uploads/2016/05/Evaluating-Welfare-Reform.pdf

In 1984, Orwell introduced the concept of “Newspeak,” language imposed by the governing Party. The purpose of Newspeak was to provide a medium of expression for the world-view and mental habits “proper to the devotees of Ingsoc, (the Party ruling Oceana)”– and simultaneously to make all other modes of thought impossible.

The “alternative facts,” of Trumpworld, politicians’ increasing use of language to obfuscate and label rather than inform, and the bastardized “research” of zealots and ideologues are creating an environment in which their version of Newspeak displaces actual conversation and distorts reality.

We. need to watch our language.

 

 

 

Polling The Uninformed

Public Policy and Governance, , , ,

Polling isn’t the same thing as survey research. The latter relies on field-tested questions and careful selection of a quantity of respondents sufficient to provide a statistically-valid result. Very few polls meet those standards.

Within the category of opinion polling, there are large discrepancies in the reliability of the information gathered. (Just ask Harry Truman or Hillary Clinton.) Some of those discrepancies occur despite good-faith but flawed efforts of pollsters; some occur because limited resources required methodological shortcuts. Too many are just garbage, generated by “pollsters” trying to peddle snake-oil of one sort or another.

My virtual friend Peter the Citizen recently shared a glaring example of snake-oil polling.

Readers may recall my previous references to Peter; he was an official in the Reagan administration–and remains an example of the intellectually-honest conservatives we’ve mostly lost. His area of expertise (back when government work demanded actual knowledge of what the hell you were doing) was welfare policy. He has consistently  debunked the assertion that TANF, the so-called “welfare reform” constantly touted by Paul Ryan and others, was a success. As he points out,

TANF is not “welfare reform” at all, but a flexible funding stream that has failed to provide an adequate safety net or an effective welfare-to-work program. In many states, it has become a slush fund used to supplant state spending and fill budget holes.

As GOP lawmakers seek to impose draconian work requirements on recipients of various social welfare programs, Peter reminds us that TANF’s work requirements are a” notable example of misguided policymaking– unreasonable, dysfunctional, and not about work.”

The real target of this particular paper, however, is the GOP’s reliance on polling to “prove” that work requirements are favored by the majority of Americans, including those on welfare–to buttress their argument that “work-capable” adults should be required to work in return for benefits. As one conservative proponent put it,

 

Voters are demanding that policymakers pursue welfare reforms that can move millions of able-bodied adults from welfare to work.”

As Peter notes, even people who support reasonable work requirements–and he counts himself as one of them– have balked at the recent attempts to add punitive provisions to SNAP and other programs. Some of the “pesky details” that pollsters don’t bother to provide to respondents are: who is to be considered “able-bodied?” Are jobs available? Is transportation? What about recipients with small children at home, or those acting as caretakers for disabled relatives?

And what about the cost of creating and monitoring this new set of rules? As Peter points out, passage of these requirements would force states to create new bureaucracies to monitor the millions of SNAP recipients to determine whether they are subject to the requirements and, if so, whether they satisfy them–but the proposal doesn’t provide any funding to support those new bureaucrats.

In the absence of context–the absence of information about these and similar “details”– responses to such polls are meaningless.

The poll questions reported verbatim in the linked paper reminded me vividly of a meeting I attended many years ago, where a state legislator from northeast Indiana shared the results of a “poll” he’d taken, the results of which “proved” that his constituents were firmly against abortion. The question–and I am not making this up–was “do you approve of killing babies?”

 

I bet I know what the poll results would be if we asked Americans “Do you approve of giving new tax breaks to rich people who are already being taxed at a lower marginal rate than Warren Buffet’s secretary?” How about “Should we let children starve if their parents don’t satisfy SNAP work requirements?”

The only thing such poll questions prove is the truth of something I learned in law school: he who frames the question wins the debate.