Helping people when they're down is admirable.
Helping people who are down learn how to help themselves is both admirable and far more sustainable, financially, in the long term.
That's why the Trump administration's decision last week to allow U.S. states to develop work-requirement programs for healthy, childless Medicaid recipients is a smart one. Under the new guidelines, individuals with disabilities and small children, women who are pregnant, and the elderly would be exempt from the work requirements.
Those most in need, then, are not affected.
Kentucky was the first U.S. state to become eligible to impose the mandatory work requirement. Illinois should get in line to become one of the next.
Medicaid is a taxpayer-funded health insurance program that was created in the 1960s to provide coverage for the most at-risk Americans, including those in extreme poverty and people with disabilities who are unable to work. But when Obamacare was enacted in 2010, it expanded Medicaid eligibility to all lower-income Americans in states that opted in. That allowed healthy, childless individuals for whom Medicaid was not initially intended to sign up for the welfare program.
In 2013, Illinois opted in to full Medicaid expansion. Since then, the state's Medicaid rolls have exploded. More than one in every four Illinoisans now are covered by taxpayer-funded Medicaid.
And, as can be expected, the costs have soared as well.
During fiscal year 2016, combined federal and state spending for Medicaid in Illinois exceeded $19 billion, an increase of 44 percent since 2012. Illinois' share is more than $5 billion, and that's only going to increase as Congress shifts more of the expansion costs to state governments.
A U.S. Senate committee is investigating the rising costs of Medicaid in Illinois and seven other U.S. states that opted into to the expansion.
In a letter to Gov. Bruce Rauner this past fall, the committee's chairman, Sen. Ron Johnson, R-Wisconsin, said Illinois' Medicaid expansion costs are exceeding initial estimates by 90 percent, nearly double.
"Costs per enrollee are also surging in Illinois, going from $1,867 in 2014 to $5,854 in 2015 – a 214 percent single-year increase," Johnson wrote. "I am seeking to better understand these rising costs and higher-than-expected enrollment, especially in states where costs or enrollment are increasing especially quickly."
Illinois is in no condition to continue absorbing these out-of-control costs. A work requirement would incentivize many healthy Illinoisans who enrolled in Medicaid through Obamacare to look for work. Some percentage of them would find it and move to privately funded insurance, saving taxpayer money.
Rauner said last week that he supports work rules for able-bodied Medicaid recipients. But he also said there aren't enough good jobs in Illinois to support it.
“We don’t have jobs available for everyone, and that’s got to be our priority – because you can force people to work but if there’s not a work opportunity, that’s not going to succeed,” Rauner said in touting reforms to tax and regulatory policies that have stifled Illinois' jobs creators.
Rauner is correct about Illinois' lagging jobs situation, but that shouldn't prevent the state from adopting Medicaid work requirements.
Under Kentucky's model, healthy adults who want to receive health care benefits would need to complete 80 hours of what that state calls "community engagement" each month to remain eligible. Community engagement can mean actually working in a job, but it also includes continuing education, community service and job training. And, to be clear, the requirement in Kentucky is 80 hours a month – not 40 hours a week, as most full-time jobs require. Illinois can form its own requirements to best fit the state.
Other federal welfare programs, such as the Supplemental Nutrition Assistance Program (otherwise known as food stamps), allow for work requirements, although the federal government makes it too easy for states to apply for and receive waivers. Illinois successfully sought a waiver for its SNAP program in 2018.
Work requirements offer good motivation for childless, able-bodied individuals to learn new skills, enhance their future earning power and become productive members of their communities.
This is a no-brainer.
Rauner should start working on Illinois' requirements immediately.