Work Requirements and Perceived Deservingness of Medicaid Recipients

• In Event: Work and Waivers in Medicaid

Abstract

Does an individual’s effort to find employment affect their perceived deservingness of being on Medicaid? As of today, four states have been granted waivers allowing them to implement work requirements as part of their Medicaid eligibility requirements. At least seven other states have filed similar requests. But are work requirements actually a relevant metric to evaluate Medicaid eligibility and deservingness? Deservingness has enjoyed a thorough treatment in the welfare literature, which generally breaks down evaluations of one’s deservingness of a social or welfare program into factors of one’s need and control over the cause of that need (i.e. risk). However, recent research finds evidence suggesting that people view issues concerning welfare eligibility in a manner that is intrinsically different than issues concerning health risk. Moreover, attitudes towards government provision of healthcare in the United States have taken a more favorable turn over the last few years since the introduction of the Affordable Care Act into the healthcare discussion. While a report from the Kaiser Family Foundation suggests that the support for a "Medicare-for-all" plan is relatively high, public sentiment towards government provision may change once we consider the fact that those who stand to benefit from healthcare expansion are more likely to resemble the Medicaid population rather than the Medicare population.

To test the relevancy of work requirements in public attitudes towards Medicaid eligibility, I use an experimental design in which respondents are shown vignettes about an uninsured individual. Respondents are randomized into treatment conditions in which the individual’s health-related behavior (how responsible they are for being sick) and their employment-oriented behavior (i.e. how much effort they spend trying to get a job) are varied. The first result is that individuals are viewed as less deserving of being on Medicaid, and of receiving federal health assistance in general, if they are personally responsible for being sick, more so than if they are less effortful in their job pursuits. The second result is that individuals are perceived as more at fault for being uninsured if they are responsible for their illness, regardless of the level of effort put into their job search. This suggests that perceptions of deservingness are constructed more around recipient’s health behaviors rather than what they do to earn their Medicaid. These findings have implications for how we understand the relevancy and necessity of work requirements in Medicaid eligibility guidelines.

Author

• Jennifer Wu