What will happen to poor families in northwest Ohio if we “reform” Medicaid the way we’ve slashed welfare? Nothing good.
It’s bad enough that lawmakers in Columbus are blocking a much-needed expansion of Medicaid, the federal-state program of health insurance for poor and disabled people. Now many legislators are talking about changing Medicaid in Ohio to impose time limits on eligibility, work requirements, and other things that supposedly will inspire personal responsibility and prevent dreaded dependency.
This sounds like the much praised, highly popular, and bipartisan federal welfare reform of the mid-1990s. Such harsh medicine appeals to people who want to believe that poverty and poor health are caused by a failure of character — a philosophy that conservative think tanks give considerable support.
But they are wrong. I have run the welfare office in one of the poorest counties in Appalachia for more than 30 years, and I can assure you it is not that simple.
Poor people struggle with character flaws; don’t we all? But bad physical and mental health, low-wage jobs, and substance abuse underlie our problems with poverty. Discrimination based on race or gender, or against ex-offenders, reflect character flaws in the rest of us that help make poverty intractable.
Welfare reform has failed because it did not address these poverty-related issues. It has not reduced out-of-wedlock births; such births have exploded. It has not reduced so-called dependency.
It has not encouraged formation of two-parent households. To the contrary, the growing number of grandparents who care for grandchildren shows the extent to which families are breaking apart.
While cash assistance rolls have dropped drastically, food stamp assistance has grown to record numbers. The most serious failure of welfare reform has been its inability to meet the basic needs of poor families with children.
In Lucas County, the cash-assistance caseload under the Ohio Works First program has dropped by roughly 4,000 people since 2011. Because of this cutback, Lucas County is getting $5 million a year less in federal funds.
Wood and Ottawa counties also have had significant reductions in their caseloads. In Fulton County, no adults receive cash assistance.
Counties have been cutting families off their cash-assistance rolls to meet a mandate that half of Ohio Works First recipients must be taking part in work activities. In the process, they have torn families apart, added to the number of families with no income, and pulled scarce dollars out of our poorest neighborhoods.
Since 2011, food-stamp caseloads for these northwest Ohio counties have remained high. The number of families who receive food stamps but have no cash income has continued to grow.
Throughout Ohio, more children now live in households without cash income (about 170,000) than in families that are receiving cash welfare (about 110,000). Overall, nearly 500,000 Ohioans have no cash income in their households.
These children live in families that double up, or triple up, in often substandard housing — if they have homes at all. The families have no money for transportation to get to work, diapers, soap, shoes, toothpaste, or other necessities.
Ohio families in the reformed welfare system get an average of $180 a month per person. Parents typically are required to work 30 hours a week. If they can overcome the transportation obstacles and other barriers to accomplishing this enormous task, they can watch their kids go hungry at the end of the month, as they struggle to keep a roof over their heads.
We insist they work. We do not guarantee that doing so will meet their basic needs.
This is the success we hope to match with Medicaid. In the every-man-for-himself world that conservatives seek, welfare reform succeeded because it slashed cash-assistance rolls. The people who got hurt were simply disposable.
Ohio has deprived 100,000 people of cash assistance in the past two years under the rules of welfare reform. These people did not disappear. They face a daily struggle to survive. Is this the kind of “reform” we want for Medicaid?
Jack Frech is director of the Athens County Department of Job and Family Services.