In the next year and a half, we here at Healthcare Triage are going to take some deep dives into issues of health policy, especially those that touch on social determinants of health and health equity. The episodes that do so will be a bit longer than usual. They’ll look a little different. They also come to you thanks to the support of the RWJF, which has generously supported their creation. We’re excited about this opportunity to really dig in, and we hope you will be, too.

For the next three weeks,we’re going to talk about work requirements. First, we’ll talk about the basics and other government work promotion efforts, then we’ll discuss what we’ve learned from TANF, and finally we’ll discuss what this might mean for Medicaid.

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Work requirements are the topic of the next three episodes of HCT.

Resources used in the making of this episode:

Income and Poverty in the United States – 2015:

How does the EITC affect poor families?:

Effective Policy For Reducing Inequality? The Earned Income Tax Credit and the Distribution of Income:

The Supplemental Poverty Measure – 2015:

Policy Basics: The Earned Income Tax Credit:

Earned Income Tax Credits:

Linking EITC Income to Real Health Outcomes:

Cost Effectiveness of the Earned Income Tax Credit as a Health Policy Investment:


Aaron Carroll — Writer

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Meredith Danko – Social Media

John Green — Executive Producer

Stan Muller — Director, Producer

Mark Olsen – Graphics

Healthcare Triage : Carrot vs Stick: The Social Safety Net, the Earned Income Tax Credit, and Work Requirements




  1. You will NEVER get support from a people or a government for a program that's based on emotive arguments alone. If you start a program based on economic incentives, then you might have support. The left seems to be champions of the emotive argument, the only problem is thanks to the internet and access to education, people aren't falling for it. "We want to help the poor blacks" turns into "We wan't to keep blacks on welfare because it ensures a democratic vote"… "We will fight for your identity" turns into "We need identity politics to exist so we can capitalize on your vote".

    I'm just asking for people to think logically. "Give them money because they're sad" will never be the answer.

  2. Question. West Virginia. If you (me) are vastly overeducated and overexperienced (while in DC area), are they ignored?
    P.S. 1. Asperger syndrome nullifies your gifts
    2. A certain warehouse that shall remain nameless was a negative experience. Colleagues say it is mean.

  3. Why don't we require that companies are required to pay enough in a given month (both hours, benefits, and pay rate) to make it instead of subsidizing Walmart with these tax credit programs?

  4. I work full time however I can not afford to pay for insurance. I would be happy to get off of medicaid, unfortunately unless my income nearly doubles I'm stuck with it. Employer insurance costs way too much for a family of six plus the insane deductibles.

  5. "Most economists agree that if we make safety net benefits too robust it disincentivises work."

    Yeah, but most economists take it on faith that you can model economies by assuming all participants are perfectly rationally self-interested, prices are created magically out of thin air, among other ridiculous notions. Do they have any evidence for this claim?

    I'll admit I'm biased. I want a comfortable UBI (meaning what we used to consider a middle class income but is now upper class) for everyone. And I believe that such a policy would reduce employment to a point.

    People who need to take care of children or loved ones would probably not get jobs because they shouldn't be working in the first place. Likewise people with disabilities who now struggle to get their disabilities recognized would get relief. Students would be able to focus on their education (which I think should also be free) and more people would stop working to get more education.

    Why should we care about that? The truth is more people are working because they have too than should, because they have good reasons why they shouldn't be working.

    Work is not our ultimate goal. Life is. Saving lives, improving lives, helping us all become our best selves. That should be our goal. The truth is we have an excess of productive capacity needed to serve that goal, but instead it's serving greed.

  6. I hate the idea of work requirements. People will be kicked off Medicaid even if they met the requirements because of the hoops they have to jump through. When you are poor, sick and/or disabled those hoops are much harder to deal with especially if you have limited access to a phone, transportation and a computer. I understand putting work requirements in place for financial programs that pay money out but putting them in place for basic lifesaving healthcare is bad policy and endangers lives. Those that say this won't impact the disabled are being naïve at best and disingenuous at worst.

  7. Are you planning on looking at the recent data in support of universal basic income? Seeing how that compares to social safety nets work requirements and EITC would be informative. Rather than relying on people eventually no longer needing access to these services you just pay everyone an actual living wage. Implementation is an important aspect of course, but there are a handful of programs that have been very successful doing this.

  8. While a good intro to the topic I got a hint that States aren't filling in most of the gaps here. My state of Nebraska provides subsidies for child care, housing, and training. Due to the high variability of cost across the US I am for local control and decision making when it comes to welfare.

  9. How about the other school of economists, who disagree that social safety net programs disincentivize work? Because there's more evidence for their position than for the one you actually mentioned.

  10. Certain costs should really be taken into consideration. I’m working class and when my state started work requirements for people getting food stamps, the thing that held people back from getting benefits was working out the schedule to get to the random parts of town between working their shitty seasonal or food service jobs that people tend to filter in and out of. The answer? Many people I know just started stealing most of their groceries. That means the “externality” was borne on the backs of grocery stores and overburdened the justice system when the simple answer actually helps those sectors and creates jobs in grocery stores because of increased spending. I know that’s just my experience but I’d be willing to bet that reducing benefits is correlated with increased crime, all other things equal

  11. @healthcare triage are those figures at the beginning of the video about workers in poverty including the earned income tax credit in the calculation of poverty, or is that basically poverty for people working without considering additional benefits?

  12. it erks me that discriminatory measures are still used in many states against working citizens who have substance abuse problems but alcohol or a prescription is ignored. can you imagine how many hard working cannabis users are excluded in many states from benefits due to state mandates for drug testing to qualify. many people will laugh at the idea, but don't kid yourself into thinking cannabis makes people worthless workers. its just an excuse to discriminate against someone you can easily identify and pick on . and a drug free america workplace policy doesnt really make sense with the available science. its just another form of suppression at this point

  13. Nice introductory video on the subject. However I think healthcare coverage should never be tied to work. We should strive for single-payer healthcare rather than further engraining the work and healthcare coverage relationship. Healthcare should be a right and not a stick/carrot.

  14. "Work requirements" are a political football that Newt Gingrich used to kick folks off welfare when the economy was good. It's effective to remind the poor that they're enslaved. When, inevitably, the economy suffers from less government spending, low demand, deregulation or higher taxes, unemployment benefits must pick up the slack and Medicaid is expanded to prevent a revolution. This back and forth should be unnecessary in a rational educated society. Alas, America is neither rational nor educated.

  15. I'm on a program exactly like this in Australia, it works to keep the dole bludgers from abusing the system, but it's a pain in the butt for those of us who do the right thing and are trying to get work.

  16. People always claim that if the safety net is too good, people will just stop working. But countries that have universal healthcare coverage…….still have people working. Most people working, in fact. It's almost like most people actually do like having an income that affords them a better lifestyle and more spending money.

  17. This issue is much more detailed than what the video is saying. It might be true if every recipient and every child of recipients were able bodied and had extended family support. Sadly, this is not true. And there is no discussion of means testing. tsk tsk.

  18. It gives people incentives to knock out lots of babies. Poor families often have so friggin' many kids because they have nothing better to do than sit around the house and make kids, and they get money for each, so eventually they reach a point where they get enough from welfare and save enough from hand-me-downs and buying bulk, they have a reason to pump out lots of unwanted and unsupported children… who then grow up and need jobs and repeat the cycle. 😒

  19. There's also a big policy problem: the threshold for what counts as "poor" varies state-by-state and program-by-program. You can make poverty level wages, yet make too much money to be covered by Medicaid in some states. So adding work requirements is a way to kick people off of Medicaid in those circumstances.

  20. The goal of work requirements is not to alleviate poverty. It's to save the government money so they can lower taxes. Politicians don't actually care to lift people out of poverty, they just want to credibly claim they do because to do otherwise is bad for their election prospects.


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