The American people will support Medicaid reform. Here's why
Democrats and the left-wing media are presently demonizing Republicans for wanting to make Medicaid more accountable and affordable.
They are counting on the program’s general popularity to inoculate it from any real change. However, a recent survey by America’s New Majority Project found most Americans support commonsense reforms to modernize and improve Medicaid – including those who use it.
For example, a majority of Americans believe able-bodied adults on Medicaid should have to work to receive the program’s benefits. The survey found 78% of Americans support work requirements for Medicaid and other safety net programs. This includes 89% of Republicans, 75% of independents, and 70% of Democrats. It also includes 66% of Americans on Medicaid and 70% of Americans who have received welfare benefits in the past year.
This fits the pattern we saw in 1996. Half the House Democrats voted with us for work requirements for able-bodied adults on safety net programs.
Support for work requirements is driven by a sense of fairness. Sixty-eight percent of American voters agree that individuals who can work but choose not to while receiving taxpayer-funded safety net benefits are committing fraud. This includes most Republican, Democratic and independent voters.
Further, contrary to the Washington press-corps narrative, most voters also consider spending reductions because of work requirements and other tested reforms to be savings rather than cuts to the program.
Other reforms are popular as well, including changes to the way the federal government funds the program to prioritize care for the neediest Americans. Most say federal funding to cover able-bodied adults (the Medicaid expansion population) should be lowered to match what it covers for the original Medicaid population of children, pregnant women, seniors and disabilities.
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Why should states be incentivized to provide Medicaid coverage for those who can work more than they are to provide coverage for those who cannot? Most Americans also say federal Medicaid dollars should be prioritized for poorer states to equalize benefits for poverty-stricken Americans regardless of where they live.
We believe the American people would also support eliminating waste and fraud in Medicaid. Democrats would have you believe that there is no waste or fraud in the nearly $880 billion state and federally funded program. However, reality indicates otherwise.
In New York, for example, the state’s Medicaid-funded Consumer Directed Personal Assistance Program pays people to stay home with their infirmed relatives. In 2014, the program had roughly 20,000 people enlisted in the program. However, after a rule change in 2015 that widened eligibility requirements, the state is now paying an estimated 623,000 New Yorkers to stay at home with their sick relatives rather than find other work. The state’s own Democratic mayor called the program "a racket."
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Further, illegal immigrants are prohibited from receiving federal Medicaid funding (except certain emergency funding), but several states pay Medicaid benefits to illegal immigrants with state-contributed funds. Eliminating this loophole would discourage illegal immigration and ease the burden of other federal programs.
That’s probably why 62% of Americans oppose their state offering Medicaid to illegal immigrants, and a similar number would support a federal law stopping states from enrolling illegal immigrants in Medicaid.
Beyond specific examples, Americans generally think that roughly 25% of federal spending is lost to fraud. Medicaid is not exempt from this belief. Americans have a broad definition of fraud beyond just criminal activity that includes cheating, failing to deliver, and waste beyond criminal behavior. There is strong support (85%) for the government to stop paying crooks as a first step toward reform.
Importantly, reforms to Medicaid and other safety net programs must be focused on moral – not purely financial – goals. Ending fraud and abuse in Medicaid and prioritizing care for the poor and disabled are popular, positive ideas. Any savings achieved by reforms are additional benefits – not the end goal.
Most Americans know Medicaid is not a perfect system and it should be reformed. Those that improve and modernize the program would be strongly supported by most Americans.
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Newt Gingrich was speaker of the U.S. House of Representatives from 1995-1999 and a candidate for the 2012 Republican presidential nomination. He is chairman of Gingrich 360.