What 'welfare reform' really means for Pennsylvanians | Opinion

Words matter. There is a lot of talk these days, primarily from Republican lawmakers, about "welfare reform." It's a catchy phrase, and lawmakers pair it with evocative images: people dependent on government programs, trapped in a cycle of poverty, or unwilling to work as Pennsylvania's budget balloons.

But when lawmakers talk about wanting "welfare reform," what are they really saying?  It's time to leave rhetoric behind and discuss the implications for Pennsylvania's budget and for Pennsylvanians.

When most people think of welfare, they probably think of cash assistance or Temporary Assistance to Needy Families (TANF): a monthly check to families in poverty to help them meet their basic needs. Today, Pennsylvania spends less than .05 percent of state general funds on cash assistance and approximately 1 percent of Pennsylvanians receive this benefit. Parents are subject to employment and training requirements, and there's a five-year lifetime cap on benefits, with limited exceptions.

The Supplemental Nutrition Assistance Program (SNAP), previously known as food stamps, is a critical program to combat food insecurity, experienced by an estimated 13.8 percent of Pennsylvanians. Research shows that providing SNAP benefits helps to improve high school graduation rates, adult earnings, and health outcomes, and reduces health-care spending. SNAP benefits are 100 percent federally funded, so changes to SNAP won't make a dent in our state budget.

That leaves Medicaid, the joint state and federal program that provides health-care coverage to low-income and disabled children, adults, and seniors. It covers 2.9 million Pennsylvanians.

Some think Medicaid is just for low-income people, but it's a critical safety net for all of us. Nearly two out of three Pennsylvanians in nursing homes are Medicaid recipients because Medicare doesn't pay for long-term care. Medicaid is the program we turn to when we are most in need of help caring for aging family members.

In 2017, the federal government mounted a sustained attack on Medicaid under the guise of repealing the Affordable Care Act. I testified before Congress on the Graham-Cassidy proposal, which would have cut Pennsylvania's Medicaid funding by $15 billion to $30 billion over 10 years. In the face of this devastating proposal and others like it, we learned that Medicaid is actually quite popular with the public. Three-quarters of people have a favorable opinion of Medicaid, and only 12 percent of people want decreased spending on Medicaid. Fortunately, Americans made themselves heard, Congress backed down, and Medicaid has remained largely unscathed.

Now, lawmakers are again gearing up to target Medicaid, this time under the cover of "welfare reform." In particular, some lawmakers are eager to apply work requirements to those receiving Medicaid. I understand their goal, and agree that we want as many people as possible to be employed. Working gives us all a sense of purpose and identity. But stripping health coverage from individuals with diabetes, or other chronic conditions that require attention, or who are battling addiction, is not going to help them find or keep a good-paying job. It is much more likely to send them into a spiral of worsening health that ultimately will cost our society even more in medical costs and in lost productivity.

The real conversation should be about supporting and improving programs that help keep people healthy.  Healthy people are much more apt to look for and find work, enabling them to support themselves and their families.

Instead of punitive proposals that could leave people without the health care and basic supports they need, we should focus on how we break down barriers for people to get good-paying jobs. Those barriers may include access to child care, transportation, educational level, or a criminal record.

I commit to working toward bipartisan solutions that support people as they seek and retain work, rather than punishing those who most need a helping hand. I welcome the conversation.

Teresa Miller is secretary of the Pennsylvania Department of Human Services.