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Opinion: Michigan work requirements for Medicaid will improve health

Jase Bolger and Lindsay Killen
Democratic gubernatorial candidate Gretchen Whitmer touted her work as the  state senate minority leader with Snyder to expand Medicaid eligibility as evidence of her ability to work with Republicans on big issues.

When Michigan expanded Medicaid through Healthy Michigan, key reforms were adopted seeking to help improve people’s health, prevent the expanded coverage from trapping people in place and avoid burying taxpayers with unsustainable costs.

Michigan policymakers have an opportunity to preserve a sustainable safety net for our state’s most vulnerable population by seeing through work and community engagement requirements for healthy adults on Medicaid. Doing so will reward the dignity of work that promotes the health and well-being of those served, help fill the strong demand for workers created by Michigan’s rebounding job market and foster stronger communities. 
Currently, Michigan spends approximately $4,300 per adult enrollee on Medicaid. The federal government funds 71% of the state’s traditional Medicaid costs. It also funds most of the costs for the additional population enrolled when Michigan extended coverage under Healthy Michigan. The federal budget initially paid 100% of those added costs, but now it pays 95%, and over the next two years, that share will decline to 90%.

However, recent reforms included a trigger to protect state taxpayers: if the federal government abandons payments or if expenses exceed savings, then the additional coverage must be dropped. 
Therefore, additional reforms can both protect working taxpayers and protect those needing help. In 2018, then-Gov. Rick Snyder signed legislation to ask the federal government for permission to implement work and community engagement requirements for able-bodied adults enrolled in Healthy Michigan. To be clear, these requirements exempt many individuals, including all of those who cannot work or need to care for others. In January, the federal government approved Michigan’s request. The approval gives lawmakers and the Whitmer administration the green light to prepare for these requirements, which are scheduled to begin in 2020. 
Unfortunately, Gov. Gretchen Whitmer’s reaction was to criticize the effort and move to loosen the requirements. This posture, that would defy the expressed wishes of the Legislature, ignores significant public support for the requirements and threatens the positive outcomes Michigan could see from the waiver’s sensible reforms. 
Michigan’s work and community engagement requirements for able-bodied adults mirror welfare reforms passed by a Republican Congress and approved by Democratic President Bill Clinton, more than 20 years ago. History has shown that such requirements have improved the lives of the men and women served. Following these reforms, welfare enrollment fell dramatically as more than half of those on welfare were able to work up and out to better lives. 
As welfare dependency decreased significantly, the nation experienced a corresponding boom in employment, particularly for women who had been trapped in poverty.

Approximately 50% of the never-married women on welfare returned to or entered the workforce for the first time. Over 66% of single women who dropped out of high school found jobs and were lifted out of poverty.

Most dramatically, nearly all mothers ages 18-24 were able to break from welfare dependency and find employment. As a result, over 1.6 million children were lifted out of poverty. 
The goal of assistance programs should be to help improve people’s lives, not trap them in government bureaucracy. Work requirement reforms show that meaningful policies can offer a ladder to independence rather than a lid on success. 
Michigan taxpayers and employers should be encouraged by the prospects for rewarding the dignity of work for thousands of people across our state. We know people thrive when their efforts are rewarded, when their hard work gets them ahead. From 2010 to 2018, Michigan added a half-million new jobs with wages that are now higher than the national average when adjusted for cost-of-living expenses. By preserving the work and community engagement requirements passed last year, healthy individuals on Medicaid will be able to take the necessary steps toward greater economic opportunity, freedom and reward for themselves and their families. 
Contrary to the fear tactics of naysayers, work feeds the human spirit and increased income lifts men, women and children from the struggles of poverty. A recent Gallup-Healthways Well-Being Index found that the longer Americans are unemployed, the more likely they are to report signs of poor psychological well-being. The same study found that unemployed individuals are more than twice as likely as those with full-time jobs to report being treated for depression.

Work is good.  Work is not a punishment. Work requirements help those able to work, protects benefits for those who cannot and respects the taxpayers who fund these programs through their own labor. 
Michigan’s current work and community engagement requirements for Health Michigan represent a reasonable approach by allowing for job training, educational work, community service, or a combination of all three to meet the requirements. 
Whitmer should embrace the full reforms in Michigan’s Medicaid program, including last year’s added work requirement. Doing so will preserve a critical safety net for the most vulnerable population and also support future prosperity for Healthy Michigan enrollees across the state — federal experience shows that’s especially true for Michigan’s women and children. 
Jase Bolger is the former speaker of the Michigan House of Representatives and the current policy advisor for the West Michigan Policy Forum. 
Lindsay Killen is vice president of strategic outreach and communications at the Mackinac Center for Public Policy.