Association for Public Policy Analysis & Management

In an effort to narrate Medicaid as a perverse incentive for entering or having steady participation in the labor force, the Trump administration has proposed a work mandate and/or community engagement activities as an eligibility requirement for “able-bodied” adults of working age who are currently utilizing services through the program and for those who will apply in the future. The notion that a “culture of poverty” or laziness among impoverished communities is misleading and does not give a full picture into healthcare dipartites in the U.S., but rather, blames victims of a capitalistic society that upholds the protestant work ethic. Historically, work requirements in social policies have been shown not to be effective, as they do not equip participants with the skills that individuals need to succeed in today’s labor market; they do not create jobs where they do not exist; do not convince employers to hire people with limited skills or criminal backgrounds; do not address the need for supportive services like child care and transportation; finally work requirements do not address employment barriers like mental or physical health problems. The protestant work ethic in the U.S. is used to justify inequality and to frame the social situation of the most disadvantaged in society, along with sanctioning the disapproval of policies aimed at improving their well-being. Race is a predictor of socioeconomic status, so these reforms will most likely negatively impact communities of color. Proposed work requirements for Medicaid ignore structural racism that leads to increased rates of premature death and reduced levels of overall health and well-being for “minoritized” groups. Like other epidemics, structural racism is causing widespread suffering, not only for African Americans and other communities of color but for our society as a whole. African Americans experience significantly higher rates of cardiovascular disease, HIV, certain cancers, diabetes, asthma, and infant and maternal mortality than white Americans do. On average, White Americans live three years longer than African Americans; life expectancy gaps can be as wide as 40 years. Work requirements as an implementation tool utilizes stereotypes about targeted participants, rather than evidence. Protestant work ethic and stereotypes are synonymous, as they give credence to language that suggest weak character that targets laziness in the labor market. The long lasting effects of stereotypes associated with work requirements in social policies stigmatize the participants – negating any intended positive outcomes; in the long-run cost taxpayers more than what they currently contribute to administer the program. Climbing hurdles over stereotypes can be even more cumbersome than navigating governmental structures due to the never ending narratives that tend to take hold on to marginalized communities. These stereotypical narratives can last a life time and be transfer over to future generations. Overall, the discriminatory language framed in Medicaid work requirements has the potential to increase heath dipartites in the U.S., as research has shown that discrimination of any kind lead to premature illnesses and increase rates of death.