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The Kentucky Medicaid Plan: Opportunity or Bludgeon?

January 16, 2018

The Trump administration has approved a Kentucky plan that will make that state the first “to require many of its Medicaid recipients to work or face losing their benefits….” [1] Beginning in July, most “most Medicaid recipients who are not disabled and aged 19 to 64” will be required to work at least 20 hours a week….” The recipients will not have to work paid jobs, but will be able to “meet the requirement through volunteer work, job training, searching for a job, taking classes or caring for someone elderly or disabled.” Moreover, pregnant “women, full-time students, primary caretakers of dependents and the chronically homeless will be exempt from the work requirement, as will people deemed medically frail.”

Now it is being promised that all of Kentucky’s Medicaid beneficiaries will be able to utilize a “program to access job opportunities, job training, volunteer opportunities, and much more – all free of charge.” [2] One hopes that this will be a serious and sincere effort on the part of the State of Kentucky, because Catholic social teaching insists that “society should, according to circumstances, help citizens find work and employment.” (Catechism of the Catholic Church, Sec. 2433) [3] As Pope Francis has pointed out in Evangelii Gaudium,

“Welfare projects, which meet certain urgent needs, should be considered merely temporary responses. As long as the problems of the poor are not radically resolved by rejecting the absolute autonomy of markets and financial speculation and by attacking the structural causes of inequality, no solution will be found for the world’s problems or, for that matter, to any problems. Inequality is the root of social ills.” (Sec. 202) [4]

And as Saint Pope John Paul II cautioned us in Centesimus Annus,

“Another task of the State is that of overseeing and directing the exercise of human rights in the economic sector. However, primary responsibility in this area belongs not to the State but to individuals and to the various groups and associations which make up society. The State could not directly ensure the right to work for all its citizens unless it controlled every aspect of economic life and restricted the free initiative of individuals. This does not mean, however, that the State has no competence in this domain, as was claimed by those who argued against any rules in the economic sphere. Rather, the State has a duty to sustain business activities by creating conditions which will ensure job opportunities, by stimulating those activities where they are lacking or by supporting them in moments of crisis.

“The State has the further right to intervene when particular monopolies create delays or obstacles to development. In addition to the tasks of harmonizing and guiding development, in exceptional circumstances the State can also exercise a substitute function, when social sectors or business systems are too weak or are just getting under way, and are not equal to the task at hand. Such supplementary interventions, which are justified by urgent reasons touching the common good, must be as brief as possible, so as to avoid removing permanently from society and business systems the functions which are properly theirs, and so as to avoid enlarging excessively the sphere of State intervention to the detriment of both economic and civil freedom.

“In recent years the range of such intervention has vastly expanded, to the point of creating a new type of State, the so-called ‘Welfare State’. This has happened in some countries in order to respond better to many needs and demands, by remedying forms of poverty and deprivation unworthy of the human person. However, excesses and abuses, especially in recent years, have provoked very harsh criticisms of the Welfare State, dubbed the ‘Social Assistance State’. Malfunctions and defects in the Social Assistance State are the result of an inadequate understanding of the tasks proper to the State. Here again the principle of subsidiarity must be respected: a community of a higher order should not interfere in the internal life of a community of a lower order, depriving the latter of its functions, but rather should support it in case of need and help to coordinate its activity with the activities of the rest of society, always with a view to the common good.

“By intervening directly and depriving society of its responsibility, the Social Assistance State leads to a loss of human energies and an inordinate increase of public agencies, which are dominated more by bureaucratic ways of thinking than by concern for serving their clients, and which are accompanied by an enormous increase in spending. In fact, it would appear that needs are best understood and satisfied by people who are closest to them and who act as neighbours to those in need. It should be added that certain kinds of demands often call for a response which is not simply material but which is capable of perceiving the deeper human need. One thinks of the condition of refugees, immigrants, the elderly, the sick, and all those in circumstances which call for assistance, such as drug abusers: all these people can be helped effectively only by those who offer them genuine fraternal support, in addition to the necessary care.” (Sec. 48) [5]

None of this justifies the cynical (perhaps sardonic) suggestion that society’s obligation to help citizens find employment is never the role of the State. On the contrary, as John Paul II pointed out, the State may “exercise a substitute function, when social sectors or business systems are too weak or are just getting under way, and are not equal to the task at hand.” And while this should only last as long as the lower orders of society prove incapable, that incapability does not relieve society of the obligation, meaning the obligation falls upon the government when necessary.

Moreover, the fact that welfare should be temporary does not mean that it should be non-existent. Nor does this mean that artificial time limits should be placed on it. Welfare should be temporary, not for punitive reasons, but because work enhances the dignity and self-respect of human beings. Therefore, the proper goal is not to time people out of the social assistance they need to survive, but to render all necessary assistance in helping them to find gainful employment so that they will need the social assistance less, or, preferably, not at all. And as Pope Francis points out, it may in some circumstances be necessary to reform the economic order in order to alleviate the necessity of welfare programs.

Kentucky’s governor, Matt Bevin, says his state’s new program is “an opportunity for Kentucky’s poor ‘not to be put into a dead-end entitlement trap but rather to be given a path forward and upward so they can do for themselves.’” That is a laudable goal, if true. But the sincerity of that goal will be reasonably doubted if the result turns out to be people in Kentucky without income and without access to medical care.

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