When confronted with the fact that 4.8 million individuals will lose health insurance due to the work requirement in the “One Big Beautiful Bill” (OBBB), Speaker Mike Johnson argued the requirement would be easy to meet because recipients could simply volunteer in their community and keep their Medicaid. Describing the “community engagement” provisions of the bill, Johnson said “If you can’t find a job, then volunteer in your community for 20 hours [a week], and you will meet the requirement.”
At the same time Johnson was touting the ease of meeting the requirement through volunteer work, the Trump administration was attempting to dismantle AmeriCorps, the federal government’s effort to promote volunteerism in communities across the country. AmeriCorps directly and indirectly supports over 2 million volunteers annually.
Volunteering opportunities of the duration and stability envisioned by the community engagement provisions of the new Medicaid law are relatively rare. Among individuals who volunteer, the median number of hours volunteered is 24 hours per year, far below the community engagement requirement of 960 hours per year. In short, volunteer opportunities in America tend to be episodic and of short duration.
Without some improved infrastructure to support long-duration volunteer opportunities, perhaps by saving and strengthening AmeriCorps, it is unlikely many Medicaid recipients will meet the community engagement requirements through volunteering.
Speaker Johnson has also emphasized the new requirements can be met by participating in job training programs. The Trump administration, however, is trying to wind down Job Corps, one of the best-known job training programs in modern American history. This program famously lifted a young George Foreman from the streets of Houston, provided him with a stable environment, and put him on a path to the Olympics, boxing greatness and, in later life, entrepreneurship.
Foreman, who described his Job Corps experience as the “beginning of me,” is an interesting case study because Johnson and many Republicans claim the new Medicaid law will help America’s young men reclaim, in Johnson’s words, “their dignity.” Without more robust support from the government to sustain job training programs, however, many young men will not meet the new requirement and will simply lose health insurance.
Much of the Medicaid debate has revolved around the notion of “able-bodied” recipients. But this is not a black-and-white issue. Many individuals are considered “able-bodied” because they do not qualify for disability benefits from the government. Such individuals, however, often have serious health impairments that prevent or limit work.
For example, among individuals denied disability from Social Security, about half report their health is poor or only fair, as compared to only 7 percent of the general population. These “able-bodied” individuals are more than three times as likely as the general population to be hospitalized during the year.
Very little support exists to help “able bodied” individuals with health problems find work in their communities, even though demonstrations show support would help. In particular, the Individual Placement and Support (IPS) model, which focuses on rapid job placement and support, has been shown to be effective at increasing hours worked among low-income individuals with health problems.
Of interest, many health centers in communities throughout the country have experience with the IPS model. Congress needs to seriously consider scaling up the successful demonstrations by funding these centers. Such action would give Medicaid recipients a chance to meet the new work requirements.
Congress could take steps this fall, through the appropriations process, to improve the situation. The first order of business could be to preserve and strengthen AmeriCorps and Job Corps. These programs have bipartisan support, including from key Republican appropriators in the Senate such as Shelley Capito. The next order of business for Congress could be to develop new programs that can assist the large number of individuals who will now have to, through some difficulty, find work in order to keep Medicaid.
With prominent Republican appropriators supporting volunteer and training programs, it is unlikely the debate will be over money. Rather, it will be whether Congress can persuade the Trump administration to spend appropriated funds and earnestly execute enacted legislation. The Trump administration has taken an assertive position on federal spending by cancelling grants Congress has funded, focusing on rescinding appropriations, and, even, raising the possibility of impounding appropriations.
One key to congressional success might be soft political power. Lisa Murkowski provided the key vote in President Trump’s win on OBBB and may have the political capital to sway the administration to rethink its views on volunteering and employment programs. It is worth noting that Murkowski has strongly objected to the wind-down of AmeriCorps and Job Corps.
Another key to congressional success is to be very specific in legislative language, which would limit executive power to ignore or change the intent of Congress. Traditionally, appropriators tend to follow an approach of setting a certain level of funding and then trusting the executive branch to follow well-thought-out rules or processes to distribute money to states, localities, non-profits, and universities.
That approach may have worked in the first Trump administration but is unlikely to work in the second. Indeed, the often-maligned idea of congressional earmarks may become an important tool for Congress if it cannot rely on the executive branch to follow traditional executive process.
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