What kind of Medicaid reform do we want?
After stopping a much needed expansion of the Medicaid Program, a group of Ohio legislators have recently introduced a new concept of “Medicaid Reform.” It involves time limits, work requirements and other elements intended to inspire more “personal responsibility” and prevent the dreaded “dependency.” This sounds amazingly like the much-praised and highly popular bipartisan “Welfare Reform” of the mid-90s. This appeals to a broad segment of the population who want to believe that all poverty and apparently ill health is caused by a failure of character. This philosophy is given considerable support by some conservative think tanks.
The problem is that they are wrong. As someone who has been running the welfare office in one of the poorest counties in Appalachia for over 30 years, I can assure you it is not that simple. There is no doubt that there are many character flaws that poor people struggle with. Don’t we all? But it is undeniably true that ill health, low wage jobs, mental health and substance abuse underlie our challenges with poverty. As well as, racial discrimination, ex-offender discrimination, gender discrimination and a host of other issues that rest with character flaws in the rest of us help make poverty intractable.
“Welfare reform” failed because it did not address the wide array of poverty-related issues. None of the stated program goals were met. It failed to reduce out of wedlock births, failed to encourage the formation of two parent households and failed to reduce “dependency”. We have had an explosion of out of wedlock births society wide. More and more families are breaking apart as is evident by a growing number of grandparents now caring for their grandchildren. While cash assistance rolls have dropped drastically, food stamp assistance has grown to record numbers reflecting a growing number of poor families.
Amid the most serious failure of Welfare Reform was that of failing to meet the basic needs of families with children.
In Ohio today there are more children living in households with no cash income than those who are getting cash welfare. Overall in Ohio, almost 500,000 people, including about 170,000, children have no cash income in their households. Only 110,000 children receive cash assistance through the Ohio Works First program.
These children are living in families doubled or tripled up in often substandard housing, many are homeless. They have no money for transportation, diapers, soap, shoes, toothpaste or many other necessities.
Families left on the reformed welfare system receive an average of $180 per person per month and the parents have a typical work requirement of 30 hours per week. If they are able to overcome the transportation and other barriers to accomplish this overwhelming task, they can watch their kids go hungry at the end of the month and still struggle to keep a roof over their heads. We insist they work, we do not guarantee that their basic needs will be met.
This is the success we hope to match with “Medicaid Reform.”
In the “every man for himself” conservative world, welfare reform succeeded because it slashed welfare cash assistance rolls. The actual people hurt were simply disposable. Ohio has cut 100,000 people off cash assistance in the past two years using the reformed welfare rules. They did not move to happy valley or disappear. They are struggling to survive.
Is that the kind of “reform” we want for Medicaid?
Jack Frech, director
Athens County Department of Job and Family Services