The four-letter word of Medicaid expansion

“Work” isn’t a four-letter word. Well, OK, it is, but not one of those four-letter words.

The Trump Administration made national headlines by opening the door to work requirements for individuals enrolling in Medicaid, or, as we know it here, MaineCare. For years, this policy prescription was a lodestar for Gov. Paul LePage and former Health and Human Services Commissioner Mary Mayhew. Time and again they would petition Obama appointees for permission to adopt these reforms. Over and over, they were denied.

In this March 22, 2017 file photo, Administrator of the Centers for Medicare and Medicaid Services Seema Verma listens as President Donald Trump speaks during a meeting at the White House in Washington. The Trump administration says it’s offering a path for states that want to seek work requirements for Medicaid recipients. (AP Photo/Evan Vucci)

Meanwhile, Democrats in Maine continually fought to expand eligibility for MaineCare, only to be met — time and again — with LePage’s veto pen. They took their battle to the ballot box in 2017, spending over $2.5 million and getting their preferred position written into law.

Like a football game, the two sides have exchanged positions on the field. LePage has to deal with Medicaid expansion, but now has a card to play with work requirements. Democrats chafe at the idea of the latter, but finally moved the ball on the former.

As lawmakers in Augusta come back into legislative session, it is time to revisit that four-letter word: work. Our elected representatives will need to do their job and find the best way forward. It will be difficult, with more than 20 individuals jockeying in the race to be the next Blaine House resident, including several legislators. Nevertheless, to borrow a phrase from Foxborough, it is time for them to “do your job.”

Work. Job. It is hard to believe such simple things create massive conflicts in our policy-making system, but it does nonetheless. The charge levied at those on the right is that they are heartless monsters who simply want to deprive the needy. Or, using an analogy, Republicans are a bunch of Scrooges, the way he was before he met the ghosts of Christmas.

That criticism is misplaced, as most is in political discourse. The idea of work requirements for certain social programs is not based in anger, greed, or malice. Instead, it stems from a belief that work is an inherent part of a person’s humanity; being a productive member of society provides self esteem and self worth, taking personal responsibility for your life. It is reflected in the famous adage: “Give a man a fish, and you feed him for a day. Teach a man to fish, and you feed him for a lifetime.”

When Republicans talk about welfare reform, this is its genesis. It isn’t that the GOP believes people don’t need help. Rather, it is that such help can have a deleterious effect on a person who has the ability to otherwise help themselves. “Help” can lead to men fleeing the workforce and families finding themselves in a poverty trap, where work — helping themselves — can leave them worse off due to byzantine rules enforced by an incoherent safety net.

Those on the left will commonly retort that those people they want to cover through MaineCare expansion are unable to work. If that is true, then we have a different problem. Maine law — before the ballot measure — focused coverage on those defined by federal law as categorically eligible for the program: children, the disabled, and low-income older adults. If there are individuals who are legitimately unable to work, then those categories should expand to include them or otherwise provide a safety-valve.

Yet for “childless adults” — not pregnant, not caretakers of children, not disabled, not elderly — the imposition of a work requirement does not seem a bridge too far. If steady work remains elusive, there are countless avenues for productive engagement, whether collecting litter or volunteering with nonprofits.

Because “work” — while a four-letter word — isn’t a bad one. It is an important part of an individual’s humanity, and something which should be encouraged by public policy. And it is time for our policymakers to go to work. So whether it is federal flexibility on welfare changes or voters opining that taxpayers should pick up the tab, those in leadership need to make the hard decisions on what’s right for Maine.

They can use whatever four-letter words they need to get there. But, yet again, like the Patriots, we charge them with one duty: do your job. So get to work.

Michael Cianchette

About Michael Cianchette

Michael Cianchette was the chief counsel to Gov. Paul LePage from 2012-2013 and deputy counsel from 2011-2012. A Navy reservist, he was deployed to Afghanistan from 2013-2014 as a trainer and adviser to the Afghan National Police. He is an alumnus of the Leadership Maine program and holds a BA in economics and political science from Boston College along with a JD and an MBA from Suffolk University. He works as in-house counsel and financial manager for a number of affiliated companies in southern Maine.