Trump and Congressional Republicans Are Working to ‘End Welfare As We Know It’
At the end of May, the Virginia state Senate joined the House of Delegates in electing to participate in the Medicaid expansion provided by the Affordable Care Act. As 400,000 Virginians look toward expanded access to health care coverage from Medicaid, millions of Americans across the country could encounter new restrictions on their access to the program. On June 21, the Republican-led House Budget Committee passed its budget for the 2019 fiscal year, “A Brighter American Future.” Among other changes, this budget would empower states to either convert Medicaid into a block grant or establish per capita caps and apply work requirements to any “able-bodied, working-age, non-pregnant adult without dependents” as a condition of Medicaid enrollment.
It seems that relentless attacks on the social safety net, characterized by deep budget cuts, work requirements, and other programmatic modifications, have a distinct purpose: The Trump administration and its Republican allies in Congress are setting the stage for the elimination of the social safety net altogether.
Undermining the Social Safety Net
Having campaigned on repealing the Affordable Care Act, it was clear that President Trump felt no strong inclination to protect the social safety net. However, the attitude of his administration toward the social safety net has been characterized not by neglect, but by active hostility. In May 2017, the Trump administration introduced a budget that Vox described as including the “largest cuts to social programs and the safety net to be proposed by a president in decades.”
The budget, “A New Foundation for American Greatness,” requested that the Supplemental Nutrition Assistance Program (SNAP), a favorite target of congressional Republicans, be cut by 25 percent over the next ten years in the amount of $191 billion. Temporary Assistance for Needy Families (TANF), the Clinton administration’s less generous replacement to Aid to Families with Dependent Children, was to lose $21.6 billion over the next ten years. For Medicaid, which congressional Republicans had already hoped to cut by $880 billion through the American Health Care Act, the administration suggested $610 billion in additional cuts within the next decade.
Although it offered little in the way of substantive details, the budget promised to “tighten eligibility and encourage work” among SNAP enrollees. In other words, expect work requirements.
By the start of 2018, it became clear that work requirements would be at the center of the Trump administration’s approach to reforming the social safety net. The Centers for Medicare and Medicaid Services (CMS) announced that it would grant waivers to states seeking to impose work requirements on “non-elderly, non-pregnant adult” Medicaid enrollees without certain disabilities. As of June 11, eleven states across the country already have either asked for or have received permission from CMS to experiment with work requirements.
Earlier in April, the president signed the Reducing Poverty in America by Promoting Opportunity and Economic Mobility executive order. It requests that the executive agencies charged with overseeing the social safety programs consider making various changes that reduce spending, albeit under the guise of furthering “economic mobility, strong social networks, and accountability to American taxpayers.” Work requirements factor critically into achieving this objective.
Though its first iteration was defeated, work requirements are a major part of the House Republican farm bill, which funds SNAP. Among other amendments, the bill calls for increasing the minimum number of hours per week enrollees are required to work to 25 by 2026 and raising the age ceiling for work requirements from 49 to 59. Analysis from the Center on Budget and Policy Priorities (CBPP) determined that the bill’s intended changes would deprive SNAP of $19 billion over the next ten years.
President Trump followed up his budget for the 2018 fiscal year with a somehow even more draconian budget for the 2019 fiscal year, “An American Budget.” It suggests a $250 billion cut to Medicaid over the next ten years and revisions to its federal funding structure. Cuts to the TANF block grant and the elimination of the TANF Contingency Fund would amount to $21 billion by 2028. SNAP would lose $17.2 billion in 2019 alone. By 2028, SNAP would witness a loss of $213.5 billion.
Shedding the Rolls
Republicans use work to distinguish the ‘deserving’ from the ‘undeserving.’ Republican Representative Marsha Blackburn articulated this false dichotomy as Republicans pushed reforming entitlement programs and social safety net programs following the passage of the tax bill. The intention, Blackburn insisted, was not to take “away benefits from those who deserve those benefits,” but “to make certain that those who deserve and need those benefits get everything that they’re entitled to.” Reforms, to continue Blackburn’s line of thinking, would only target ‘undeserving’ enrollees: presumably those who are unemployed.
Beyond the fact that Republicans’ efforts to separate the so-called ‘undeserving’ from the ‘deserving’ are morally appalling, they are factually dubious as well. Many social safety net enrollees already work: Analysis from the Kaiser Family Foundation determined that 60 percent of adult Medicaid enrollees were working either full-time or part-time as of 2016. Is work the only characteristic that renders one deserving of benefits? Do the 14 percent not working due to illness or disability, the 6 percent not working because they are enrolled in school, or the 12 percent not working because they are caregivers, according to that same analysis on enrollees’ 2016 work status, not qualify as deserving? Could anyone in good faith dismiss an unemployed veteran, of which there are many, as undeserving?
More disturbingly, this problematic distinction can put access to benefits at risk for both the supposed ‘undeserving’ and the ‘deserving’ by justifying work requirements as preconditions for eligibility. Threatening access to assistance, with an eye toward potentially eliminating assistance altogether, is ostensibly the Trump administration’s purpose in pushing so fervently for work requirements.
Perhaps nowhere is the threat to benefits presented by work requirements more salient than in SNAP. Those unable to satisfy the work requirements established by the House farm bill would face a loss of benefits for a full year. With each failure to comply, individual SNAP enrollees would be denied access to the program’s benefits for three full years. Such rigid standards, which mirrored those in the previous version of the bill, could have especially adverse effects on older enrollees, those with inconsistent work schedules who might have difficulty adhering to the weekly work expectations, and those with mental and physical disabilities unable to complete the paperwork to obtain an exemption or unable to prove that they qualify for an exemption at all.
At least two million Americans could face either lost or diminished access to SNAP as a result of the implementation of the farm bill.
Medicaid enrollees, once shielded from work requirements, are now vulnerable to them: The waiver guideline from CMS empowering states to attach work requirements to Medicaid eligibility is written broadly enough to apply to most non-elderly Medicaid recipients (albeit with exclusions for pregnant women and some of those with disabilities). As a result, at least 25 million Americans across the country could find themselves newly subject to work requirements. Kentucky alone estimated that its implementation of a work requirements waiver, though recently blocked by a federal judge, would cost 97,000 Kentuckians their Medicaid coverage.
The waivers from CMS might seem lenient by comparison if the House Budget Committee budget, which would extend work requirements for Medicaid enrollees across the country, is enacted.
So far, the administration and Republicans on the House Budget Committee have declined to specify who exactly would be subject to work requirements in their budgets beyond singling out “able-bodied” adults. Current exemptions will probably continue. However, who is to say that such exemptions will continue to apply? Next year, the administration may push for certain work requirements for the elderly and pregnant women the year after that. Social safety net programs may be forced to apply stricter parameters for disability exemptions, redefining those with certain physical, emotional, and mental disabilities as “able-bodied” and subsequently subjecting them to work requirements too. Subjecting these once-protected groups to work requirements that they have no hope of fulfilling could jeopardize access to benefits for them and their dependents. Work requirements have the effect of shedding the rolls while supporting the appearance of continued operations.
Funding cuts have the effect of shedding the rolls too. Cuts in federal funding to the social safety net would present states with a choice: Either offer more money to maintain current levels of operation, or kick enrollees off the affected programs.
Take TANF as an example. According to the CBPP, the Trump administration’s budget is expected to cost TANF 45 percent of its value by 2019—mostly through a cut to basic assistance, the cash that goes to families. This loss, along with the elimination of the Contingency Fund, would restrict TANF’s ability to assist Americans. Basic assistance will likely be the first source of cuts as states scramble to respond to the cuts. TANF reaches only 23 out of every 100 low-income families with children, but that number could be depressed further over the course of the Trump presidency as states contend with cuts.
Alterations to Medicaid funding could present states with similar financial challenges. Both the Trump administration and the Republican-led House Budget Committee budget support setting per person coverage caps and converting parts of Medicaid into a block grant. The federal funding cuts that would result from implementing these reforms could ultimately push the financial burden of maintaining Medicaid onto the states. States would likely be compelled to push Medicaid enrollees out of the program.
Between federal funding cuts to TANF and Medicaid, millions could consequently see a loss of benefits.
On June 21, the Trump administration introduced a proposal recommending, along with other reforms, consolidating various social safety net programs, including SNAP, under the Department of Health and Human Services (HHS). HHS would be renamed the Department of Health and Public Welfare (DHPW). A new Council on Public Assistance, to be located within the DHPW, would be charged with establishing and enforcing work requirements within all federally administered social safety net programs.
The consolidation of social safety net programs sounds like the first step in justifying budget cuts: An argument could be made that programs housed within a single entity require less financial support. Lower funding evolves into restricted access to assistance. Like work requirements, the consolidation of the social safety net could have the effect of reducing individual program caseloads while preserving the illusion of assistance.
If enough social safety net enrollees are pushed off the social safety net, it will exist in name only.
Playing the Long Game
Congress is unlikely to pass the 2019 fiscal year budget from the Trump administration. However, the president’s priorities, to an extent, could ultimately come to fruition somewhere down the line.
Consider SNAP specifically. The Trump administration asked for $191 billion in cuts to the program over the next decade for the 2018 fiscal year. Congress rebuffed this proposal, but the administration followed up with a suggested $213.5 billion over the next decade for the 2019 fiscal year. If the Trump administration year after year suggests progressively deeper cuts, suddenly the originally requested $191 billion in cuts appear reasonable. In this way, the Trump administration may be playing the long game.
This theory becomes especially plausible considering the fact that many Republican members of Congress, including those 213 Republicans who voted for the House farm bill and those 21 Republicans who have so far voted for the House Budget Committee’s budget, share President Trump’s zest for cuts and support for work requirements when it comes to social safety net programs. Republican Senator John Kennedy recently spoke out in favor of mandatory work requirements for Medicaid recipients across the country. Even before the passage of the deficit-increasing tax bill, which favored the wealthiest Americans, congressional Republicans made it clear that they intended to offset the tax cuts with cuts to the social safety net. Should the Trump administration push hard enough for deep funding cuts consistently in the future, it might find receptive collaborators where a mutual ideology already exists.
A Case for the Social Safety Net
Some Republicans might claim that a social safety net that is too generous promotes a culture of dependency in which those not engaged in gainful employment are allowed to mooch off the government. Restrictions, then, would nurture independence and work.
There are several problems with this argument: First, it’s predicated on the incorrect assumption that social safety net benefits can be used as a substitute for a living wage. The approximately $1.40 per person per meal offered to SNAP enrollees, for example, is hardly enough to live off of on its own.
Second, available evidence indicates instead that it is the benefits themselves that make gainful employment possible. For example, majorities of both non-working and working Medicaid enrollees observed that the health care coverage provided by Medicaid made it easier to look for work and maintain or perform work in studies of Medicaid enrollees in Ohio and Michigan. SNAP, in some cases, was shown to increase take-home pay.
Finally, research has shown that restrictions in the form of work requirements are not as helpful in encouraging the transition to gainful employment as Republicans argue. TANF operations in Kansas have proven to be an interesting case study. Sixty-seven percent of studied Kansas parents forced to leave TANF due to work sanctions were engaged in some form of work the year before leaving the program. Sixty-eight percent of such Kansas parents were engaged in some form of work the year after leaving TANF, implying that work requirements were associated with neutral effects on employment at best. In terms of the ability to transcend poverty, work requirements were not shown to have been related to overwhelmingly positive consequences. At least 70 percent of studied Kansas parents forced to leave TANF due to work sanctions were living in some form of poverty four years after leaving TANF: Forty percent of such parents had no earnings, while thirty percent of such parents had earnings below the deep poverty level.
If the Trump administration and its Republican allies in Congress get their way, the more discouraging results observed in Kansas could be replicated nationally.
President Bill Clinton famously promised during the 1992 presidential campaign to “end welfare as we know it.” President Trump and congressional Republicans are telegraphing that they plan on ending the social safety net as we know it on their own terms: By ending it entirely.