By Adam Edelen
Aside from the obvious moral implications of adopting an approach certain to significantly reduce the number of insured Kentuckians, Governor Matt Bevin’s work requirements for Medicaid recipients will produce a new bureaucracy that is costly, intrusive and doomed to fail.
They will also guarantee a reversal of the recent improvement in Kentucky’s notoriously bad health metrics.
As someone who, like most Kentuckians, was not born to wealth or position, I fully embrace the notion that self-reliance and self-worth go hand-in-hand. I’ve worked every day of my life. As state auditor, I passionately rooted out waste and fraud — motivated by a clear sense that the taxpayers’ hard earned money demands stewardship rather than abuse.
The problem with the governor’s Medicaid directive isn’t that we don’t all endorse the notion of earning benefits, it’s that his is a talking point in search of a policy. Good policy makes for good politics. It is regrettable that the two have been confused here.
The vast majority of poor Kentuckians are working poor. Single mothers, stuck in minimum-wage jobs, earn by the hour. The out-of-work coal miner spends hours looking for work, making application far beyond the limits of his hometown. The bitter truth isn’t that the poor aren’t working hard enough, it’s that the work they’re doing doesn’t pay enough.
Requiring the working poor to perform at least 20 hours of community service weekly — for health insurance — is both an insult and a pending bureaucratic disaster. Subjecting the working poor to more vigorous tracking requirements than that of parolees is an absurdity of the first order.
The business of accountability is an important one. Tracking the “community service” activities of 150,000 Kentuckians enrolled in Medicaid (as estimated by the administration) is an enormous undertaking, one that will require an army of bureaucrats building a massive surveillance apparatus in order to monitor somewhere in the neighborhood of 140 million volunteer hours a year.
Who will track these hours and confirm their authenticity? Will we send the “accountability bureau” into places of worship and nonprofits, interrogating faith leaders and overburdened community servants about who showed-up and when?
It is a foundational tenet of conservatism that once established, bureaucracies tend to grow larger and less responsive. Civil libertarians are rightfully concerned with the potential for the abuse of privacy that comes with a government database tracking citizens’ activities. One doesn’t have to be of their ilk to envision how this one could easily run amok.
For four years I served as Kentucky’s taxpayer watchdog, uncovering billions of dollars in previously untracked public spending. My work, and the work of our auditors, resulted in jail time for lawbreakers and a record of reform ranging from rape kits to boards of education. This isn’t easy work. A routine audit of a county government requires a staff of trained, professional auditors working hundreds of hours.
Are we really prepared to spend that much money and manpower to guarantee the volunteer hours of the working poor? And who will decide the legitimacy of the Medicaid “community service?”
Will those who choose to protest, say, an abortion clinic 20 hours weekly qualify? What about those who would choose to volunteer as a patient escort at the same clinic? Complicated isn’t it? The resulting bureaucratic directive will prove a bonanza for First Amendment lawyers and a headache for the rest of us.
Other states have tried the Bevin approach. All have failed, growing governments and wasting money — neither of which is welcome in a state the desperately needs effective stewardship of every scarce public dollar.
Certainly, there is a better way. The Kentucky Auditor of Public Accounts has been decimated by budget cuts over the last decade, as have resources for the Cabinet of Health Services’ Office of the Inspector General. These two investigative agencies have the background and skill set to ferret out those abusing public assistance. Both should be sufficiently resourced to do precisely that.
By all means, let’s catch every abuser of the public trust, from welfare cheats to corporate executives who take economic development incentives yet fail to deliver the promised economic impact.
But building a big government surveillance apparatus and criminalizing the working poor pursuing health insurance is wrong and wrongheaded. Kentuckians deserve better than cynical political posturing masquerading as serious policy.
Adam Edelen, a Lexington entrepreneur, is a board member of the University of Kentucky’s College of Public Health. He served as State Auditor from 20012-2016.