In January, the Trump administration released new guidelines that would allow states to begin imposing work requirements on Medicaid recipients. It was a kindness, really: According to Seema Verma, administrator of the Centers for Medicare and Medicaid Services, meaningful work is essential to “economic self-sufficiency, self-esteem, wellbeing and … health.”
Well, for some of us.
Since the announcement, states have raced to implement new work requirements, which will have the effect of bumping hundreds of thousands of their poorest citizens off the Medicaid rolls. But in more recent months, a number of GOP-controlled states have been quietly crafting waivers that would end up shielding rural, white residents from this new scheme for self-esteem.
It seems an unusually transparent move, even for a party that tends toward the blatant in its disdain for those not seen as “real Americans.” But most of all, it’s an example of how much-touted moral policy stances — such as solicitude for the “dignity of work,” or “zero tolerance” for drugs or “extreme” immigration vetting — often give shelter to less attractive tribal loyalties.
In Ohio, Michigan and Kentucky, work-requirement waivers would include exemptions for counties with the highest levels of unemployment, which are overwhelmingly white, rural — and GOP-leaning. But most of these exemptions would do nothing to help people of color who live in high-unemployment urban areas, because they live in places where countywide unemployment numbers are skewed by the inclusion of wealthy suburbs.
In Michigan, for instance, Medicaid work requirements would exempt those living in counties with an unemployment rate of over 8.5 percent — but leave out high-unemployment (and majority-black) cities such as Detroit and Flint. According to an analysis of state data done by The Post, whites would account for 85 percent of those eligible for the unemployment exemption, despite making up only 57 percent of the potentially affected population. African-Americans, in contrast, would constitute a mere 1.2 percent of people eligible for an exemption, despite being 23 percent of the affected Medicaid population.
Let’s grant that, as a country, the United States holds close to heart that Protestant ethic that makes paid work an essential marker of adulthood, responsibility and citizenship. And there are arguments to be made for the value of employment, especially here. Jobs aren’t just a wage; for many people, they provide structure to life, an identity, a sense of community, as well as useful skills. Employment can offer a sense of satisfaction, the knowledge that one’s contributions to society are needed and that one’s presence and performance matter.
Whether it’s healthy that we derive so much of our identity from our work is an entirely different question, but the evidence would suggest that this is what we do. One National Bureau of Economic Research study found that as the unemployment rate increases by one percentage point in a given county, the opioid death rate rises by nearly 4 percent and emergency room visits rise by 7 percent.
So, why not share this bounty of employment with all? Because despite all of the moral preening, for all the Trump administration’s solemn proclamations about the “dignity of work” and the economic “principles that are central to the American spirit,”these Medicaid regulations — and the thinking behind welfare administration more generally — are rarely as moral and all-embracing as their proponents would have us believe.
It’s simply impossible not to see intent in racial disparities as large as the one these Medicaid waivers would generate. The GOP is making clear that these work requirements aren’t truly about the virtue of work, in general; they are about who needs to be working, and how much. And the answers to such questions are rarely grounded in the publicly espoused morality of help for all but in far more tribal considerations. Who deserves assistance, no strings attached? As it turns out, it’s those who look, think and vote like me. Who needs to get a firmer grip on those bootstraps and work to earn my help? Everyone else.
But of course, this is the problem that besets all of our considerations around welfare, access to aid and government support. Perhaps the GOP officials who crafted these rules have convinced themselves that they are based on well- considered, universally applicable moral ideals. Work is good! Take responsibility! No mooching! But they ought to ask themselves: Why, then, do these policies so frequently end up giving a free pass to their own?
These Medicaid exemptions are a perfect example of a classic double standard — “morals for thee, but not for me.” Dig a little deeper, and it becomes clear the “morals” are a sideshow.