Amid discussion of whether healthcare is a human right, it should be noted that no one ever has an absolute right to get it free from anyone else.
Yet with healthcare, as with food, the state often has a duty to provide it to those who, despite their best efforts, would be incapable of providing it for themselves.
This is why President Trump has the right idea this week with his administration’s new guidelines for Medicaid. The Department of Health and Human Services says it is inclined to let states impose work requirements for childless, able-bodied adults in the Medicaid program. Trump is right to approve the necessary waivers, and we hope more states will apply for them.
A work requirement makes plain that the welfare state is a helping hand for people in need, even long-term, but that it should never become a way out of a regular adult life for those who can and should support themselves but prefer not to.
For most Medicaid recipients, this won’t change anything. The Kaiser Family Foundation reports that three in every five nonelderly Medicaid adults, both parents and the childless, already work anyway, and four in five are in families where someone works. The disabled comprise many of the remaining cases, and they won’t be affected either.
The number of childless, able-bodied adults on Medicaid who are not working is thus not a very large share of the 25 million nonelderly adults on Medicaid. But they are a large body numerically, and they should not be left free to burden the rest of us when they are capable of fending for themselves.
Like all welfare programs, Medicaid should be reserved for those in need, those whose best efforts are not or can never be enough. By restricting the program to such cases, the state is duly diligent and safeguards its solvency for those who will need help in the future.
Various states have already imposed work requirements for other public welfare programs, at times with dramatic and positive results. In Maine, 80 percent of childless, able-bodied adults on food stamps immediately dropped out of the program when a work requirement was introduced, a clear sign that they didn’t need food assistance that badly. In Kansas, 75 percent of childless, able-bodied adults dropped out rather than provide evidence of their employment, volunteering, or job search.
Kaiser cautions that a work requirement for Medicaid could cause trouble if a state bureaucracy is unable to verify employment. But setting aside this light nod to rectifiable inefficiencies in government operations, there is no defensible argument for giving free healthcare to able-bodied, childless grown-ups who refuse to meet an easy work requirement. Even the phrase “work requirement” is something of an exaggeration. Those willing merely to search for a job, volunteer, or attend opioid addiction treatment will be credited for their efforts as well.
There will be cynical efforts by the Left to portray Medicaid waivers and work requirements as harmful to the poor. But nothing could be further from the truth. Appropriate and tailored work requirements preserve welfare programs so that their funding goes to help those in need and is not wasted on others. Getting people out of morally enfeebling dependency is also a good thing. There is nothing compassionate about taking money set aside for the poor and spending it on people who can’t be bothered to look after themselves.