Opinion: Medicaid Recipients Who Can Work, Should Work
By Sarah Lee
After a federal judge blocked Kentucky’s Medicaid work requirement, President Donald Trump’s Council of Economic Advisers released a study that concluded many people who receive Medicaid benefits can work but choose not to.
The study explained, “The American work ethic, the motivation that drives Americans to work longer hours each week and more weeks each year than any of our economic peers, is a longstanding contributor to America’s success.”
The council’s study revealed that 60 percent of working-age Medicaid recipients who aren’t disabled worked fewer than 20 hours per week. Other studies, such as one from the Foundation for Government Accountability, found nearly 7 million Medicaid expansion enrollees are not employed.
These studies (and many others) justify the Trump administration’s push to institute welfare reform policies. In April, Trump signed an executive order that instructs federal agencies to reform out-of-control welfare programs, including by instituting work requirements for able-bodied adults.
Expanding Medicaid to include able-bodied adults without dependents was a central strategy of the Affordable Care Act. President Barack Obama and other Democrats reasoned if Medicaid — which was originally only intended to help the elderly, disabled and indigent by providing subsidized health insurance — were made available to able-bodied Americans, it is likely many would enroll in the program, which is exactly what happened. Tens of millions of Medicaid enrollees were added during Obama’s tenure, pushing the country closer to having a single-payer health care system.
Other than trying to keep people hooked on Medicaid, thus making single-payer health care more likely to become a reality, there is no reason to oppose work requirements for healthy Medicaid recipients, especially since numerous studies show Medicaid offers inferior health coverage for enrollees compared to private health insurance. This shouldn’t be surprising, either. Due to Medicaid’s low reimbursement rate, fewer health care providers, especially specialists, accept Medicaid patients.
Under the leadership of Seema Verma, the Centers for Medicare and Medicaid Services has dedicated itself to granting to the states the flexibility they need to reform their Medicaid programs. To date, CMS has approved waivers for state-based reforms such as work requirements for 19 states.
The Council of Economic Advisers study suggested it might be necessary to pass federal legislation that mandates states impose work requirements to help ensure state lawmakers are doing everything they can to help Americans move from government dependency to self-sufficiency. “Low employment rates of non-disabled working-age recipients suggest that legislative changes requiring them to work and supporting their transition into the labor market would affect a large share of adult beneficiaries,” the report’s authors concluded.
Because Congress has repeatedly failed to repeal and replace Obamacare, the Trump administration has taken matters into its own hands. States should take advantage of this important opportunity to reform their skyrocketing Medicaid programs by embracing free-market reforms, including the expansion of health savings account and direct primary care programs. To do otherwise would be to continue to entice more people to join the inferior Medicaid system, trapping many families in poverty.
ABOUT THE WRITER
Sarah Lee (firstname.lastname@example.org) is a research fellow at The Heartland Institute. She wrote this for InsideSources.com.
Why Jewish giving to Israel is losing ground
August 15, 2018
Hanna Shaul Bar Nissim
Postdoctoral Fellow, Maurice and Marilyn Cohen Center for Modern Jewish Studies, Brandeis University
Hanna Shaul Bar Nissim receives funding from The Institute for Law and Philanthropy, Tel Aviv University. Findings presented are an outcome of a collaborative research project between the Maurice & Marilyn Cohen Center for Modern Jewish Studies, Brandeis University and The Institute for Law and Philanthropy, Tel Aviv University exploring Jewish philanthropy toward Israel.
American Jews donate at high levels to charity. One way they support causes in the U.S., Israel and other places is collective, often through large grant-making organizations.
In researching this organized philanthropy, I’ve observed that the proportion of Jewish institutional giving to Israeli causes has fallen since 2009. I believe that several factors, including demographic and social changes, a diminishing perception of Israel as being in need and concerns over the Palestinian-Israeli conflict have probably been driving this decline for years.
More recently, Israel’s increasingly conservative policies on social and religious issues, which are often at odds with what most American Jews support, might also be playing a role.
A tradition of support
American Jews proved a major source of philanthropic support for the Israeli state and Israeli society throughout the 20th century. A network of Jewish fundraising and advocacy groups have long organized collective donations and lobbying efforts.
These groups make major donations to large Israeli nonprofits, like the Jewish Agency for Israel and the Joint Distribution Committee, which then distribute them to smaller, local nonprofits.
However, knowledge about the actual scope of Jewish philanthropic contributions to Israel is limited. Data collected by my colleagues at Brandeis University indicate a steady increase from US$1.05 billion annually in 1975 to $2.05 billion in 2007 in real dollars.
And data from the Israeli Central Bureau of Statistics indicate that charitable gifts to organizations in Israel, from sources in the U.S. and other foreign countries, kept growing – rising from $1.95 billion in 2009 to $2.91 billion in 2015.
A smaller share
I am conducting a study with a colleague at Brandeis University, Matthew Brookner, in collaboration with the Institute for Law and Philanthropy at Tel Aviv University. Together, we are exploring patterns and trends in Jewish grant-making to Israeli causes that have not been completely understood until now.
To understand Jewish giving to Israel we mined data using the Foundation Search database, which provided us with large amounts of digitized financial information.
Federations and foundations
To see what’s changing in this kind of giving, we split the data into large grants over $500,000 and smaller grants. Our initial findings are based on an analysis of 21,062 large grants allocated by 1,235 Jewish funding organizations between 2000 and 2015, totaling $46.3 billion.
We found that the total scope of donations for Israel grew between 2000 and 2015. While more money is contributed to Israeli causes, the share of Jewish giving going to Israel from the overall contributions – which also includes Jewish causes outside Israel and non-Jewish charities – has declined.
Among other things, we found that the top funding organizations to Israeli causes are still Jewish Federations, communal fundraising institutions that operate in most North American metropolitan areas. These federations gave Israeli causes a total of $2.3 billion between 2000 and 2015.
But giving from private foundations and pass-through organizations – intermediaries that transfer donations to other groups – now rivals that revenue source. Those kinds of donors provided $2.2 billion in support each during this period.
Two-thirds of the grants supporting Israeli causes were allocated to U.S.-based organizations, such as Friends of the Israel Defense Forces. We also found the peaks we expected to see in large grants for Israeli causes in the years 2002 and 2003, 2006 through 2008 and 2011.
These upswings coincided with major events including the Second Intifada, the Second Lebanon War and the conflict in Gaza in 2008 and 2009.
Giving fell, however, following the Great Recession. The single point of divergence in this time followed the devastating 2010 Mount Carmel forest fire near the Israeli city of Haifa.
Change of pace
Although American Jews still donate more to Israel amid wartime emergencies, we did not see similar spikes in giving following a major military operation in Gaza in 2012 or in 2014 when the conflict in Gaza flared again.
And overall, the proportion of Jewish giving going to Israeli causes as a share of donations is decreasing as is the share of giving to non-Jewish causes. Meanwhile, giving to Jewish causes outside Israel is rising.
In fact, only 9 percent of organized Jewish giving was allocated to Israeli causes in 2015. In comparison, 58 percent supported non-Jewish causes and 32 percent backed Jewish causes outside Israel.
This decrease in the share of giving for Israeli causes was evident as early as 2009, excluding the surge in donations in 2011 driven by the Mount Carmel forest fire.
A growing divide
Explaining this decrease in donations should acknowledge the existence of political, economic and demographic trends impacting U.S. Jewish philanthropy. In addition, Israel is becoming by many measures more socially, politically and religiously conservative, exacerbating points of contention between many U.S. Jews, who are more likely to be liberal than conservative, and Israel.
Among the deepest disagreements is what conversion to Judaism should require to be recognized by Israel’s government – which has repercussions in terms of which foreign Jews have a right to immigrate to Israel and live there as citizens.
After the question of “Who is a Jew?” had been hotly debated in the U.S. and Israel for more than three decades, the Knesset – Israel’s parliament – granted the Chief Rabbinate, a government ultra-Orthodox establishment, a monopoly over the conversion process to Judaism in the summer of 2017.
This move excluded Reform, Conservative and Reconstructionist conversions altogether, raising objections from American Jewish leaders. Although Israel subsequently delayed the bill’s enactment, the criticism voiced by many American Jews has not abated.
Another source of friction between the world’s two largest Jewish communities is the ongoing efforts of non-Orthodox Jewish denominations to create a prayer space shared by women and men at the Western Wall, a holy site in Israel.
President Donald Trump’s policies toward Israel have aggravated this divide, especially due to his decision to move the U.S. embassy to Jerusalem from Tel Aviv.
More erosion ahead
Israel’s increasingly conservative social and religious policies may be gradually eroding Jewish philanthropic support for Israeli causes.
I believe this trend will only grow, following the passage of a new surrogacy law that instituted state support for surrogacy pregnancies – excluding gay men seeking to become fathers.
Another contentious law may have an even deeper impact. It declared that Jewish people have the exclusive right to self-determination in Israel. Its passage brought on massive demonstrations in Israel and elicited objections from some of the most prominent American Jewish organizations.
The road to India’s partition
August 14, 2017
Associate Professor of History, University of Dayton
Haimanti Roy does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.
University Of Dayton
University Of Dayton provides funding as a member of The Conversation US.
As citizens of India and Pakistan celebrate 71 years of their independence on August 15, they will also remember 1947 as the momentous year of their simultaneous birth. That year, the British quit their “jewel in the crown” and partitioned colonial India on the basis of religion.
What followed in the aftermath of the partition was one of the largest forced migrations of the 20th century. Over the next two decades, nearly nine million Hindus and Sikhs moved into India and approximately five million Muslims to a spatially fragmented East and West Pakistan. This movement was accompanied by horrific mass violence which targeted women through rape and abduction and left an estimated million dead.
Scholars have called the partition the “other face of freedom.”
But, as late as the summer of 1946, hardly anyone could have foretold that partition would be the political solution to the transfer of power at the end of the long nationalist struggle for independence. Nor would people have predicted that it would lead to such horrific violence and mass uprooting, causing long-term memories of exile and loss.
So what led to this division? And why 1947? As a scholar of South Asian history, I would suggest that there are multiple and complex reasons.
The long road
In fact, many divisions had been a long time in the making.
Early on, the British justified their subordination of India by claiming that Indians were socially and morally weak. And they mistakenly viewed their Indian empire as a set of distinct communities. They also saw them as being in conflict with each other, ignoring the interwoven cultural and shared traditions at the time.
It was this British view that eventually translated into giving political representation based on religious identities. This meant that Indians could gain political power (however limited) only through separate electorates based primarily on their religion. Thus, Hindus could elect their own Hindu representatives and Muslims could do the same.
Scholars note that these trends taken together led to the emergence of Muslim separatism from the 19th century onwards. It culminated in the idea that Hindus and Muslims were distinct and that India comprised “two nations” sharing different histories and cultures.
The idea of Pakistan
Other scholars have argued that it was the politics of the 1930s onwards that led to the partition.
Here the key debate was about the demand for Pakistan, a separate homeland for Muslims. One of the reasons the idea of Pakistan started to gain popularity was that Mohammed Ali Jinnah, the leader of Muslim League, the main Muslim political party, did not define clearly the geographical coordinates of Pakistan. Indeed, the very vagueness of the location of Pakistan was what helped in getting support from Muslims across India who were divided by language, culture and class and, most of all, geography.
Pakistan carried different meanings for different groups: To farmers in the Eastern state of Bengal it meant a “peasant utopia” where they would be free of landlord oppression. For the elite Muslims in northern India, it meant a “new Medina,” a new civilizational heart for Muslims in the subcontinent and beyond.
It should be said, however, that the idea of Pakistan was not supported by all Muslims: More than half of them would remain in India after partition.
The road of many paths
As the debate over Pakistan developed, other events were taking place as well. After 1935, Indians received a larger share of political representation under colonial rule. Such devolution of power, however, meant little as Indians were forced to join British efforts in the Second World War.
It was in the middle of the war, in August 1942, that Gandhi called for the British to “Quit India” permanently. The famine in Bengal in 1943 that ravaged the lives of an estimated three million Indians added to perception of the colonial state’s negligence and inability to continue to administer its Indian empire.
All in all, the stage was set for discussions on India’s independence.
After the war, there were many options on the negotiating table. These included the possibility of a united India with a strong center where Muslims would be equal citizens but a political minority, with no hope of leading a government. The Indian National Congress, the largest and main political party, had long advocated for such a united India.
However, given that in British India Muslims were around 25 percent of the population, a united India would be dominated by majority Hindus. Under British rule, Muslims had come to enjoy representation through separate electorates and reserved legislative seats.
For Jinnah and the Muslim League then, the key issue was to ensure that Muslims had equal political representation in independent India. This was not going to be possible under the Congress plan for a unified India with a strong center.
Another option was to make India and Pakistan part of a federation. There were many other such combinations that were proposed. The inability of Indian political leaders, however, to work together at this crucial moment made negotiations difficult.
Some scholars argue that it was Jawaharlal Nehru, leader of the Indian National Congress at the time, who insisted on a “secular” united India and thereby paved the path for a division.
However, partition was not, even at this late date, a necessary condition for the creation of the new nation of Pakistan. One possibility would have been India and Pakistan sharing political power in a federation.
By the summer of 1946, the leaders of the Congress (claiming to represent majority Indians irrespective of caste and religion) and the Muslim League (claiming to represent Indian Muslims) met in Simla, the summer capital of British India, and later in Delhi with the British representatives regarding the contours of India’s freedom and the fate of Pakistan.
Two things severely impacted the direction such negotiations would take.
The first was the start of communal riots between Hindus and Muslims in Calcutta in August 1946 which quickly spread to different parts of eastern India. Although Gandhi’s efforts were able to quell the violence by December that year, the damage had been done.
Whether Hindus and Muslims would be able to live together – even though they had for centuries – became an urgent question in the minds of both Indians and British leaders. Partition emerged as a plausible solution.
Indeed, sizeable groups of Hindus from both Bengal and Punjab – the two major provinces that would be split between India and Pakistan – began to urge for such an outcome along with the Muslim League’s followers.
Amid such confusion, the last viceroy of India, Lord Louis Mountbatten arrived in India from London in March 1947 with the mandate to transfer power quickly. Mountbatten, in an attempt to resolve the political impasse, persuaded many Indian leaders to accept a partition.
Consequently, Mountbatten’s Plan of June 3, 1947 announced that not only would India gain independence in August 1947, a full year ahead of schedule, but also that it would be partitioned so as to accommodate the demand for a Muslim homeland.
Decisions made behind closed doors would decide the fate of millions.
This piece was first published on August 15, 2017 and was updated to reflect the 71 years of partition of India and Pakistan.