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Economic Policy


GOP EYES NEW WORK REQUIREMENTS FOR MILLIONS ON MEDICAID, FOOD STAMPS


THE DEMAND FROM HOUSE SPEAKER KEVIN MCCARTHY COMES AS THE WHITE HOUSE REJECTS
TALKS ON POLICIES THAT COULD CUT BENEFITS TO LOW-INCOME AMERICANS

By Tony Romm
and 
Rachel Roubein
April 11, 2023 at 6:00 a.m. EDT

House Speaker Kevin McCarthy (R-Calif.) at a bill-signing ceremony in March. GOP
leaders are looking at proposals to require recipients of some federal aid to
work. (Jabin Botsford/The Washington Post)

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House Republicans are eyeing new work requirements for millions of low-income
Americans who receive health insurance, money to buy food and other financial
aid from the federal government, reprising the party’s historic crusade against
welfare as some lawmakers seek new ways to slash spending.


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In recent weeks, the GOP has focused its attention on two anti-poverty programs:
Medicaid, which enrolls the poorest families in health insurance, and food
stamps, which provide grocery benefits to those in need. Top lawmakers including
House Speaker Kevin McCarthy (R-Calif.) have publicly endorsed rules that could
force some enrollees to find a job and work longer hours — or risk losing the
government’s help entirely.



The demands largely come in the context of a brewing fight over the federal
budget. Many Republicans have said that federal aid programs offer a way for
policymakers to boost U.S. workforce participation while saving Washington money
— a stance that infuriates Democrats, aid workers and others, who say such
changes could harm vulnerable families still reeling since the coronavirus
pandemic.

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The debate in some ways resembles the Republican-led campaign against so-called
welfare queens in the 1990s, when a politically resurgent GOP — then under the
leadership of House Speaker Newt Gingrich — secured a dramatic restructuring of
the government’s social safety net. The resulting overhaul, enacted by President
Bill Clinton, slashed cash benefits for millions of Americans in ways that GOP
leaders now cite as a model.

“I don’t think hard-working Americans should be paying for all the social
services for people who could make a broader contribution and instead are couch
potatoes,” Rep. Matt Gaetz (R-Fla.), a member of the far-right House Freedom
Caucus, said at a news conference last month.

House GOP eyes bill to cut spending, raise debt ceiling amid stalemate

At the center of the standoff is the debt ceiling, the statutory limit on how
much the U.S. government can borrow to pay its bills. Lawmakers must raise that
cap as soon as June or risk a federal default — an economic calamity that GOP
leaders have tried to exploit in hopes of advancing their agenda.

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In a letter published late last month, McCarthy called on President Biden to
negotiate and spelled out his party’s latest demands. That included steep
spending cuts and new policies “strengthening work requirements for those
without dependents” — a reference to children — citing the fact that Biden
supported the welfare-to-work approach adopted under Clinton in the ’90s.

Biden has refused to haggle over the debt ceiling and instead demands that
Republicans raise it and preserve the country’s credit without conditions. The
president has expressed a willingness to discuss broader fiscal issues with
McCarthy, but White House aides have outright rejected any changes to food
stamps and Medicaid that reduce enrollment.

“The President has been clear that he will oppose policies that push Americans
into poverty or cause them to lose health care,” White House spokesman Michael
Kikukawa said in a statement. “That’s why he opposes Republican proposals that
would take food assistance and Medicaid away from millions of people by adding
burdensome, bureaucratic requirements.”

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Still, top Republicans have unveiled a battery of proposals, including one
targeting Medicaid, hoping to deliver on a long-sought conservative goal to add
work requirements to the insurance program.

In February, Gaetz released legislation that would deny benefits to able-bodied
adults unless they work for 120 hours per month, volunteer or participate in a
work program for 80 hours, or participate in a combination of those activities.
The congressman did not respond to a request for comment.

It is unclear whether other Republicans would support that approach. Gaetz’s
bill does not yet appear to have any co-sponsors, but the hard-right bloc to
which he belongs, the House Freedom Caucus, generally endorsed work requirements
in its own demand letter last month. The group didn’t specify any programs, but
Rep. Scott Perry (R-Pa.), the caucus’s chairman, later told The Washington Post
that he wants nationwide work requirements for Medicaid.

Biden administration warns of ‘damaging’ effects from GOP budget plans

The new conservative push is especially potent because Republicans’ razor-thin
House majority gives its hard-right faction powerful leverage. It also arrives
at a tumultuous time for Medicaid, which saw enrollment balloon by about 30
percent at the height of the pandemic.

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During the crisis, lawmakers enacted temporary rules that essentially prevented
states from culling their Medicaid rolls. But those prohibitions expired on
April 1, opening the door for state health officials to begin reevaluating
eligibility. Approximately 15 million low-income Americans are ultimately
expected to lose their coverage as a result, including 6.8 million who still
qualify for the program, according to federal estimates in August.

At the White House, Biden has leaned into health care as a campaign message
ahead of a potential 2024 reelection bid. In an interview last month, his
Medicaid chief criticized work requirements.

“On work requirements, I think the administration’s position is really clear
about being very much concerned about putting up barriers to people getting
coverage,” said Chiquita Brooks-LaSure, the administrator of the Centers for
Medicare and Medicaid Services. “It’s critical that we have coverage in this
country … and there are other ways to really address making sure that people are
able to find employment.”

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The two parties have previously battled over work requirements in the safety net
program. In 2018, the Trump administration issued optional guidance for states
to implement work rules in Medicaid for the first time, contending it would
incentivize healthy people to find employment. Democrats seized on the issue,
arguing the policy would hurt vulnerable Americans and was designed to curtail
Medicaid enrollment.

Thirteen states adopted such rules under President Donald Trump. Once Biden took
office, however, his Medicaid agency quietly began to send letters rescinding
states’ Medicaid work requirements, which already faced a flurry of legal
challenges and weren’t in effect. Only one state, Arkansas, imposed a work
requirement for a significant period. Over more than nine months, about 18,000
adults lost coverage for failing to comply with the rules, and only about 1,900
re-enrolled in the program before a federal judge blocked the work rules.

Since then, the state’s new governor, Sarah Huckabee Sanders (R), has said she
will try again under different rules — while a work requirement in Georgia is
slated to begin this summer. Nationally, Republicans have argued that such
mandates could increase labor force participation, even as the unemployment rate
remains low.

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“This is the perfect time to have work requirements because people are needed,
they’re wanted,” said Rep. Brett Guthrie (R-Ky.), chairman of the House Energy
and Commerce health subcommittee. “Wages are rising because there’s a shortage
of workers, so it’s a good opportunity for people to better themselves moving
forward.”

For some Republicans, though, the push doubles as an opportunity to reduce the
federal debt, which exceeds $31 trillion. At a House hearing in early April,
Rep. Darin LaHood (R-Ill.), the new chairman of the House Ways and Means
subcommittee on work and welfare, stressed that lawmakers had to ensure more
“accountability for federal taxpayer dollars.”

In doing so, Republicans have signaled their focus could be broad in scope,
potentially including the benefits the government provides for housing, child
care and other key services.

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“We should be exploring every possibility to get our fellow Americans back into
the labor force, including strengthening work requirements across all government
programs,” added Rep. Jason T. Smith (R-Mo.), the leader of the House Ways and
Means Committee.

Tasked to prepare a spending blueprint for the 2024 fiscal year, the House
Budget Committee last week specifically called attention to what it described as
a “culture of government dependency,” citing an uptick in spending in Medicaid
and other federal programs, including food stamps, unemployment insurance,
disability benefits and tax credits for low-income parents with children.

The panel’s chairman, Rep. Jodey Arrington (R-Tex.), said in a previous
interview that Republicans are “going to look at health care” with the goal of
reducing costs, stressing that decisions “haven’t been made” about what to
propose on Medicaid. Broadly, though, Arrington long has endorsed work
requirements on aid programs, especially in the case of food stamps.

As pandemic benefits wind down, a reckoning for households and economy

Formally known in Washington as the Supplemental Nutrition Assistance Program,
or SNAP, food stamps provide lower-income households with an average of more
than $230 each month for groceries, often paid through a debit card.
Approximately 41 million people are currently enrolled in the program, according
to the government.

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Under existing law, SNAP already requires many adults without children to seek
employment and training. But GOP leaders argue that the rules are too lax,
exempt too many beneficiaries from work and open the door for states to make too
many exceptions.

One key bill from Rep. Dusty Johnson (R-S.D.), a top ally of McCarthy, would
rewrite some of the program’s rules, chiefly by subjecting Americans without
children between the ages of 49 and 65 to SNAP work requirements. (Current rules
for these adults apply only up to 49.) The proposal, which has more than three
dozen GOP co-sponsors, also would limit states’ ability to waive some of those
rules.

“This is not about balancing the budget on the backs of anyone,” Johnson said in
an interview, adding that there is “no reliable pathway out of poverty” that
doesn’t involve work, education and training.

But the changes could force more than 10 million people off food stamps,
according to the left-leaning Center on Budget and Policy Priorities, which
estimates the cut would affect 1 in 4 SNAP recipients. Even those who retained
monthly food aid could face additional hardship, because they could be forced to
work longer hours in ways that affect their ability to care for their children,
CBPP found.

Johnson disputed that analysis. Still, it could be the second blow to SNAP
recipients in recent months, after Congress allowed a pandemic benefit program
to expire in March, slashing millions of families’ food benefits by an average
of $82 a month, according to the Food Research and Action Center. Some
Republicans still have signaled discomfort over targeting SNAP in the ongoing
budget debate.

Democrats, meanwhile, have pledged to oppose any such changes, setting up a
clash that could come to a head even if the GOP does not pursue changes in talks
around the debt ceiling. Lawmakers also must act by Oct. 1 to approve
legislation known as the Farm Bill, which authorizes a bevy of federal farm and
nutrition-related programs.

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