Food stamps, Medicaid, and erring on the side of compassion

While much public attention is (appropriately) focused on the Senate bill that would shred the Medicaid program, House Freedom Caucus members are pushing a proposal to shred other parts of the social safety net: welfare, or Temporary Assistance for Needy Families (TANF), and food stamps, or Supplemental Nutritional Assistance Program (SNAP). Both the Senate BCRA and the Freedom Caucus budget proposal aim to cut spending on these crucial assistance programs while granting large tax breaks that disproportionately benefit the wealthy.

Representative Jim Jordan (R-Ohio) has put forward a budget proposal to cut $200 billion from SNAP and TANF over the next decade, and claims it will be painless because additional work requirements will spur people to get jobs. But University of Michigan poverty expert Luke Shaefer stresses to Vox’s Tara Golshan, “The single thing we can be absolutely sure about with a bill like this is that it would increase hardship significantly for struggling families.”

Rhetoric vs. evidence on public assistance

A common argument for cutting safety-net programs is that people who could be working are instead taking advantage of public assistance, and that if you take that assistance away, they’ll get jobs. One big problem with this that the majority of non-elderly families getting Medicaid and SNAP include at least person who’s working – but their wages simply aren’t enough to cover their families’ needs.

Proposals to slash spending on safety net programs tend to rely on two methods: Changing eligibility requirements and/or making beneficiaries jump through more hoops to get the benefits. This can include mandating that beneficiaries re-verify their income, employment, or other situations several times a year, and kicking them out if all the paperwork isn’t in place at each point.

For instance, Texas has started requiring financial eligibility verifications for children receiving Medicaid at months five, six, seven, and eight of their enrollment. Many of those who are kicked out of the program temporarily regain coverage within a few months, but in the meantime lack the health coverage that can play such an important roll in their development. The number of Texas children experiencing gaps in their Medicaid coverage more than doubled since this practice began, NPR’s Shefali Luthra reports.

We have national data on what happens when a safety-net program adds strict work requirements, because “welfare reform” under President Clinton imposed both work requirements and time limits on families seeking cash assistance. The idea was that making cash benefits conditional on employment or qualified educational activities would lead to better employment outcomes for parents living in poverty, but that’s not how it has turned out. In a policy brief summarizing evidence that accumulated in the two decades since that policy change, the Center on Budget and Policy Priorities’ LaDonna Pavetti concludes “Stable employment among recipients subject to work requirements proved the exception, not the norm” and “The large majority of individuals subject to work requirements remained poor, and some became poorer.”

Tighter eligibility requirements and more-burdensome (re)verification increases demands on beneficiaries and the agencies administering the program. Enrollment will fall, but many of the people losing benefits won’t be losing them because they no longer need the assistance, but because they lack the resources to meet all the requirements. Cutting benefits might look like short-term savings, but children unable to concentrate on schoolwork because they’re hungry or adults unable to manage their diabetes are likely to require more assistance in the future, not less. Researchers have found that access to food stamps is associated with increased economic self-sufficiency for women, and that adults with access to Medicaid are more likely to improve their employment situations.

Erring on the side of compassion

I don’t doubt that a small number of Medicaid and food stamp recipients have made a conscious choice to opt out of working and receive public benefits instead. This number, however, is dwarfed by the number who might seem on paper to be freeloading but who would much rather be working – and are more likely to reach that goal with continued assistance.

At healthinsurance.org, Steve Anderson works through the numbers on the adults covered by the Medicaid expansion. Of those without disabilities, many are already working or in school, others are caring for family members, and others are looking for work. That leaves 3.2% of Medicaid expansion adults who, on paper, are “able-bodied” and don’t have one of the above accepted reasons for not working (though, as Anderson points out, many of them were working but have been laid off). Anderson concludes, “This nation desperately needs a healthcare ‘fix’ – but it needs one that incorporates compassion and humanity, and not vilification.”

If the choice is between a) accepting a small number of freeloaders and allowing millions of families to keep Medicaid and food stamps and b) taking benefits from millions in order to decrease the likelihood of freeloading, I’ll err on the side of compassion and argue for people to keep the benefits that allow them access to food and medical care. Better yet would be to increase the supports, like skills training and childcare assistance, that can put work within reach for more beneficiaries.

From an economic perspective, making it harder for people to get SNAP and Medicaid will cost states money and limit future economic growth. From a perspective of compassion, it’s more important for people in need of benefits to receive them than to prevent those who might not need them from getting them. From a moral perspective, it’s more important to preserve the safety net than to cut taxes. The bottom line is that such a wealthy nation ought to be able to assure its poorest families can get food and medical care.