The conservative case against Medicaid work requirements

Freedom. Privacy. Not having to listen to some whinging bureaucrat with a social science degree from Directional State University tell you what to do with your life. These are all part and parcel of what it means to live the good life. They are also, ostensibly, among the basic tenets of American conservatism. But they apparently mean very little to Gov. Asa Hutchinson (R), under whom thousands of Arkansans are being forced to spend 80 hours a month attending pointless "job training" seminars, filling out endless paint-by-numbers online job applications, performing mandatory "volunteer" work (a.k.a. slave labor), and writing meaningless book reports about the whole tedious experience, which must be submitted to a state website every night by 9 p.m. sharp.

When I say "forced" I don't quite mean that they are being made to do so at gunpoint. But very nearly that. Unemployed residents of the state who wish to receive Medicaid benefits for which they otherwise qualify must engage in this meaningless performative activity. More than 16,000 Arkansans have lost their coverage after failing to comply with these regulations — more than 4,500 in November alone. The Arkansas program is one of many theoretically approved by the Trump administration, but it's the only one to have taken effect so far. A similar one in Kentucky has been halted thanks to a lawsuit.

Why would any conservative think that this is a good idea? If the core insight of the GOP's blinkered version of libertarianism is that the state is not, fundamentally speaking, very good at doing things, why would a Republican governor set up a vast state apparatus to oversee the finding of employment for his citizens? Surely any minimal savings that might be had from dropping a few supposedly undeserving "freeloaders" is outweighed here by the cost of administering the workfare program — the endless state-employed minders who are charged with ensuring that all the reports about the valuable time spent watching PowerPoints about the possibility of learning to code and sweeping the floor of the American Legion for free are filed on time. This has nothing to do with saving money. It is organized cruelty for its own sake.

Subscribe to The Week

Escape your echo chamber. Get the facts behind the news, plus analysis from multiple perspectives.

SUBSCRIBE & SAVE

Sign up for The Week's Free Newsletters

From our morning news briefing to a weekly Good News Newsletter, get the best of The Week delivered directly to your inbox.

From our morning news briefing to a weekly Good News Newsletter, get the best of The Week delivered directly to your inbox.

Sign up

Many Republican governors have refused to allow the expansion of Medicaid in their states, on the grounds that their citizens would no doubt prefer to pay more for health care. This is their decision, of course, though it's worth pointing out that in the red states where the expansion has been allowed it has been both popular and wildly successful. Even the term-limited Gov. Phil Bryant of Mississippi, the deepest of deep red states, appears to be quietly coming round. But the expansion will do very little good if it's introduced alongside these bizarre, expensive, and ultimately pointless requirements. Health care, like food and water and shelter, is either something we all deserve or not. If you don't think it is, let the idle and the inefficient die in the streets from untreated illnesses. If you do, treat it the way, i.e., unconditionally, without recourse to tiresome interference from the state and the résumé website industrial complex.

Of course, there is another way of getting around the Arkansas dilemma. Able-bodied citizens who have no work could simply be given jobs under some kind of guaranteed employment scheme along the lines of that proposed recently by Sen. Bernie Sanders. But this is not likely to happen in the South any time soon. When Asa Hutchinson decides that capital and American productive capability are too important to be left in the hands of mere private actors and comes out in favor of, say, nationalizing the oil industry or guaranteeing a family wage for all Arkansas, he should feel free to experiment with these silly make-work health-care schemes. Till then, he should keep his government hands off of decent people's Medicaid.