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Amy Walter: What does it sound like to be on government assistance?

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Speaker 2: I have received government food stamps, and Medicaid, and housing. These social services enabled me to attend college. My whole professional career was in social services of some kind. I could not have accomplished this if I had not been for food stamps, Medicaid, and housing assistance.

Speaker 3: Back in the late '70s, I signed up for the WIC program, which was Women and Infants Nutrition Program. I was very grateful for that. They provided good food, dairy products.

Speaker 4: I qualified for food stamps and used them because even though I was working full-time, minimum wage is so abysmally low, I couldn't afford to pay rent, utilities, and feed myself.

Speaker 5: We signed up for SNAP and Medicaid because we're so far below the poverty level.

Speaker 6: I've had food stamps several times before when I've been unemployed. I normally get off of them when I no longer qualify, once I have a job.

Speaker 7: I did have to ask for food stamps when I was between jobs, and grateful for it.

Amy Walter: Earlier this year, President Donald Trump signed an executive order directing federal agencies to strengthen current and introduce new work requirements for low-income Americans who receive government assistance. At the Department of Housing and Urban Development, Secretary Ben Carson has called for raising rents for those who receive housing assistance, a way, he says, to encourage residents to find work. In the ongoing debate over the Farm Bill, some lawmakers are calling for food assistance to come with a work requirement.

Earlier this year, the Centers for Medicare and Medicaid, for the first time, allowed states to apply for waivers that would tie Medicaid to work. Proponents of these policies say they aren't trying to punish the poor, but to incentivize them to work and thereby help them out of poverty.

Newt Gingrich: Somebody owes you money. Life isn't fair. Somebody ought to pay you something. It doesn't work. You'll never solve America's problems through redistribution. You have to convince people to engage in wealth creation.

Amy Walter: Newt Gingrich, when he was House speaker. Critics say this will only further hurt poor Americans. I'm Amy Walter, and today on The Takeaway, a look at government assistance programs and the working poor. Who deserves these benefits, and should the government require work to receive them?

Speaker 9: I'm an old, old lady. I might lose what little benefits I do get now.

Wanda Rogers: This is not a joke. It's not a game. It's not play. This is for real.

Erica Lestrange: It always feels like we're climbing uphill. Sometimes it just feels like it doesn't matter how hard I work.

Frances Arrudgeo: My name is Frances Arrudgeo. I'm from Providence, Rhode Island.

Amy Walter: Frances is a 77-year-old retiree who knows all too well how quickly life can fall apart and what it's like to have to turn to the government to get by.

Frances Arrudgeo: When my husband was very young, he was a boxer, and in his '50s, brain injury, which they now call CTE, began to show up. It started with Parkinson's disease and escalated into dementia. I was young. I had to work. Eventually, he had to go into a nursing home since I could not take care of him at home anymore. At that point, I could not afford a nursing home, which even then was extremely-- It was around 1989, 1988. Nursing homes were still extraordinarily expensive.

I had to apply for Medicaid, which thankfully was granted to us, and they completely covered my husband George's nursing home stay. He was there for eight years because he was young and strong and healthy in heart and lungs, but of course, his mind was not functioning as it should. He broke his hip at one point during that time, and that was also covered. When he turned 65, he was eligible for Medicare, but I will always, always be extremely grateful for the government service of Medicaid for my husband. Without it, I have no idea what might have happened.

Amy Walter: We pressed Frances. What would have happened without government-provided Medicaid?

Frances Arrudgeo: I don't know. I honestly think sometimes that we would have been very possibly homeless because I just don't know how we would have paid bills or survived, really.

Amy Walter: Or take the case of Wanda Rogers.

Wanda Rogers: I'm 47 years old, I live in St. Louis, Missouri, and I work at McDonald's on Hampton.

Amy Walter: Wanda has a house full of kids, a part-time job, and relies on government assistance.

Wanda Rogers: My household, it's me. I have four daughters, 12 grandkids, which all whom I take care of. Right now, I'm on low-income housing and I receive food stamps. I work 20 hours a week. I work Monday through Friday. I do all kind of work in there. I prep, I help cook, I work on fries, I help clean the lobby. I pretty much do all the jobs that's required in McDonald's.

Amy Walter: Every two weeks, Wanda gets a paycheck for around $230.

Wanda Rogers: I have to decide sometimes on paying different bills. My rent is $488 a month. Then that still leave me with light and gas bill, and to try to have money to buy household supplies. It's hard trying to do that off of a job where you're not making that much money, and you don't have another income coming in, and you're a single parent. It's decisions I have to make every month on what I'm going to do, how I'm going to do it, what I'm going to pay, what I'm not going to pay.

Amy Walter: Missouri, where Wanda lives, has a work or job training requirement. At one point, the state's food stamp program abruptly cut Wanda's benefits down to just $19 a month.

Wanda Rogers: They said that they wanted me to be working at least 40 hours a week in order to receive my food stamp benefits, but if I wasn't, I had to go to school. The time that they wanted me to go to school is the time I have to work. They had cut my food stamps down to $19.

Amy Walter: Wanda got lucky. She went down to her local resource center and pleaded her case. They removed the school requirement.

Wanda Rogers: He said, "Well, since I'm going to take this out, I'll take your food stamps up. He took them up to $119 a month and completely took out me having to go to school.

Amy Walter: Wanda says if working full-time at her job was a possibility, she'd do it.

Wanda Rogers: I could work full-time, but that's the hours my job gave me. I have to work the hours that they give me. I can ask for more hours, but a lot of times when you ask for them, they don't really want to give them to you. I've just been working the hours they giving me. I just recently asked her again, "Can I get my 40 hours a week?" She hasn't got back to me and told me whether I was going to be able to work them or not.

Amy Walter: Wanda hopes that people could understand how important these benefits are to her and to her family.

Wanda Rogers: I just wish those people that's up there trying to take things from us would look at it from our perspective and see how it's really affecting us. This is not a joke. It's not a game. It's not play. This is for real, and it's really affecting people's lives. I wish they would think about it before they take all this stuff that they're trying to take from us, because if we're struggling now, we're really going to be struggling.

Amy Walter: Then there's the case of Erica Lestrange, a transgender woman on no government assistance.

Erica Lestrange: I'm a hairdresser in Waterville, Maine. I work part-time, renting a booth. Made it my own little business. I'm married to my wife, Alice Lestrange.

Amy Walter: Erica has a hard time putting in enough hours of work, in part because she has a medical condition that makes it difficult for her to have too many hair appointments in any given week.

Erica Lestrange: I'm only able to work part-time due to the fact that I have severe nerve damage in my hands. A typical day looks like, for me, when I do work, I work on Wednesdays and Saturdays because I have to have my appointments spread so far out. I'm only able to take about three appointments a day. I have to keep them spaced out just because I have to have times for my hands to rest. I come home in a fair bit of pain, but I just count my blessings that I still can do this work somewhat.

Amy Walter: Her limited income means she and her wife have made sacrifices.

Erica Lestrange: My wife Alice and I live together in a house with some housemates. There's five of us total who live together. We're all just struggling to make ends meet, and we found that this works the best.

Amy Walter: Here's the thing, Erica and Alice are technically just above the federal poverty line. Even though they feel poor, they don't qualify for any government benefits, but they are hoping that Maine will soon expand Medicaid, a benefit they would qualify for. Last November, voters in Maine approved Medicaid expansion, but Governor Paul LePage has been stalling its implementation. A judge ruled this week that he must allow it to move forward and provide coverage by July 2nd.

Access to health care would help Erica, but given her medical condition, she's worried she won't be able to work enough hours to gain her benefits. Then there are other challenges she faces in the workforce as a trans woman.

Erica Lestrange: Being a trans woman in this country, especially under current political ideologies and some social ideologies, I am very blessed that I live in Maine, and as progressive as Maine is there's still some differences of opinion about whether or not we belong in the workforce and whether or not we deserve treatment and how we deserve to be treated in the workforce. I have to be careful with choosing what I do for work. So much of the work out there, for someone who doesn't have training in other fields, like I don't have a bachelor's degree, I don't have a graduate's degree, certainly, that really limits what I can do.

Most of it's call center work or retail work, and they all involve so much use of my hands that I end up in the same situation that I have as a hairdresser. I find myself boxed in by these limitations.

Amy Walter: Still, she tries to make ends meet with what she has.

Erica Lestrange: We've just tried so hard to make ends meet without the need of public assistance and to make things work. It always feels like we're climbing uphill. I was raised in Mississippi, and I moved to Maine when I was 16. Where I'm from, it was always said you just have to work hard. As long as you work hard, everything's going to be okay. Sometimes it just feels like it doesn't matter how hard I work, things are still in my way. There are still barriers to getting to what I need.

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Amy Walter: For the rest of the hour on The Takeaway, we take the deepest of dives into government assistance programs. The idea of work requirements for government benefits isn't new, but do they work? What does the data tell us?

Speaker 13: A randomized controlled trial is the best way to understand whether a policy works or not.

Amy Walter: Also, the history of the working poor in this country and shifting attitude towards what they deserve and at what costs.

Edward Berkowitz: Programs, they go in and out of favor, but it helps to have this rationale that you can't be cheated on, like the food stamps, or that the cause is good, like in Medicaid, rather than simply giving people money. That's very suspect as in welfare.

Amy Walter: One Republican lawmaker who says the work requirement is better than a handout.

Senator Emmett Hanger: This can be actually something that helps people, can help our economy, because it's structured in a way that, really, as I view it, is more a hands-up rather than a punitive request.

Amy Walter: Plus, we ask you, should people have to work in order to receive these benefits?

Iris: Hi, this is Iris from Woodcliff Lake, New Jersey. I do believe that people receiving government benefits should work some minimum number of hours, except when child care or caring for a sick relative will cost more than a person earns.

Seth: Hey, my name is Seth from Hannibal, Missouri. I'd say no, they shouldn't have to, but the problem is we have far too many able-bodied folks taking advantage and corrupting our welfare system.

Jenna: Hey, this is Jenna calling from Somerville, New Jersey. No, I don't think you should make people work for government benefits. The entire point of benefits is that people can have a safety net.

Dolly: My name is Dolly, and I'm calling from Salt Lake City. I think when you just hand things to people, they become entitled and, actually, at times, angry that you didn't give them more of what they think they need.

Amy Walter: Call us at 8778-Mytake or tweet us, The Takeaway. Government assistance, who deserves it, and should they be required to work for it. Now let's step back a moment and look at how we got here.

Edward Berkowitz: My name is Ed Berkowitz. I'm a professor of history and public policy at George Washington University.

Amy Walter: Oh, thank goodness, a history professor.

Edward Berkowitz: Our social welfare system really begins in 1935 at the Federal level. Franklin Roosevelt proposed in Congress pass the Social Security Act, our big magnum opus of social welfare laws.

Franklin Roosevelt: We have tried to frame a law which will give some measure of protection to the average citizen and to his family against the loss of a job and against poverty-stricken old age.

Edward Berkowitz: The next big thing that happened was 1956, Congress and Lyndon Johnson, who was the congressional leader at the time, helped to pass disability insurance so that you could get benefits even if you were not 65, but you were somehow disabled, unable to work. 1965, when we added Medicare.

Lyndon Johnson: Millions do not now have protection against the economic effects of sickness, and the time has now arrived for action.

Edward Berkowitz: Then in 1972, we indexed Social Security benefits to the rate of inflation, creating so-called COLAS. In 1983, when Ronald Reagan was president, they solved a financial crisis by making certain adjustments, and that is the Social Security program that we have, which is by far our most popular social welfare program.

Ronald Reagan: It assures the elderly that America will always keep the promises made in troubled times a half a century ago. It assures those who are still working that they, too, have a pact with the future.

Edward Berkowitz: The welfare programs, by way of contrast, have a different history. They start out as uncontroversial. Everybody thought that dependent children, blind people, and elderly people who could show they were poor were entitled to assistance. No one asked too many questions about that. Some states began to give away money lavishly for those. In the 1950s, it really began to change. The biggest change was that the elderly, who had been the biggest group of welfare beneficiaries, they were now covered by Social Security. There weren't that many blind people.

There weren't really that many permanently and totally disabled people who had been added in 1950, but there were a lot of dependent children. This becomes a discussion in the 1950s, what should we do about that? By now, race is becoming much more of an issue in welfare. When the program was first created in states like Florida, really was a whites-only social benefit, but in the 1950s, as African Americans begin to go from the south to places like Detroit, Chicago, or New York, they go to places where they can get welfare. The roles begin to become a little more Black than they were before.

The people getting welfare were no longer just widows who everyone thought of as very deserving, but often people where the father had never been present or just wasn't there for one reason or another. Those single-mother families were very controversial.

Speaker 16: We found that many of the folks that came into our city had no plans. They were just vegetables in a sense.

Edward Berkowitz: What the Kennedy administration decided to do, they said, "Well, we can fix this so-called rehabilitation approach," but turned out to be very unsuccessful. The welfare rolls continued to just grow and grow and grow during the 1960s. By the end of the 1960s, the people in Congress were saying, "No, we have to do something about this. We have to send a signal that you can't just get welfare."

Speaker 17: We expect of you what we expect of ourselves and our own loved ones, that you will do your share in taking responsibility for your life and for the lives of the children you bring into this world.

Edward Berkowitz: When Ronald Reagan became president of the United States, there was a major law passed called the Family Support Act that tried to make the point that we'll give the mothers social services, but in return, they have to work. The culmination of this whole process was in 1996 when Bill Clinton was president and Newt Gingrich was speaker of the House.

Speaker 18: We have a historic opportunity to make welfare what it was meant to be, a second chance, not a way of life.

Speaker 19: Re-establish the volunteerism and the civic compassion that worked in the 19th century.

Edward Berkowitz: We created this new law, which really changed that welfare program so that it became a block grant in which the federal government gave the states a certain amount of money and said, "We're not going to pay you any more. This is not an entitlement. That's all you get." Each of these programs has its own history, and you ca n see that they get out of sync with one another. Social Security becomes progressively more popular. Welfare becomes progressively less popular.

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Amy Walter: When you hear the term welfare, what does that mean to you, and what does that mean from a clinical and from an empirical standpoint?

Edward Berkowitz: If you're a policy wonk type, then you understand that welfare is a program of assistance to people who are in defined categories, they're elderly, they're blind, they're disabled, they're dependent children, and only paid into families or individuals who can pass what they call a means test. The means test means that somebody asks you, how much money do you have in the bank? How Much money do you have? Do you have a car? Do you have a house? People that pass those means tests, in other words, they can prove that they're poor, they're eligible for welfare.

That's what the wonky types mean by welfare. But by social insurance, that's usually the thing that's opposed to welfare, and social insurance is a program that pays benefits as a right to people, and is usually paid for by some sort of payroll tax or employer's tax or that sort of thing. That Social Security is social insurance, which is a much more secure entitlement than welfare, which is means-tested.

Amy Walter: Tell us too how we got to this place where certain programs I'm thinking about, maybe Pell Grants or subsidized housing, have a different perception in the minds of a lot of folks than say, food stamps or Medicaid.

Edward Berkowitz: All of which have these complicated histories. As someone said about food stamps, it's food stamps, it's not beer stamps. The idea is that you get the food stamps and you can spend it on food. Everybody needs food. People today complain that people are spending the money on things like potato chips, but still, it's food stamps. Whereas, say, public housing, that's a little bit more of a tricky thing. Why are you entitled to public housing when other people have to go out into the private housing market and have a difficult time there?

That looks like more of a pure welfare benefit, and therefore it's stigmatized. Now, Medicaid, there's another interesting thing. Medicaid was created in 1965, when Medicare was created, and it was almost an afterthought. Even the people that are inside the policy process and in the Johnson administration, it wasn't looked at very carefully. That's now our biggest medical program. There are more people on Medicaid than any other medical program in the country by far.

In 1965, the idea was, if I'm on welfare because I'm a dependent child, or I'm blind, or I'm old, or I'm disabled, I should have the right to medical care. We call that program Medicaid, but that program developed in different ways. For one thing, it became the major provider of long-term care, and those people are not like welfare people. Those were just people's grandmothers. Gradually, Medicaid becomes less of a welfare benefit and more of just our healthcare benefit that we have.

That reaches a culmination when Barack Obama is president, when he passes the Affordable Care Act. Really, the main thing that's going on in the Affordable Care Act is the expansion of Medicaid. It's become a more respectable program. Programs, they go in and out of favor, but it helps to have this rationale that you can't be cheated on, like the food stamps, or that the cause is good, like in Medicaid, rather than simply giving people money. That's very suspect, as in welfare.

Amy Walter: Edward Berkowitz is a professor of history and public policy at George Washington University. Under the Trump administration, states can now require residents to work in order to receive Medicaid, and this is new. In all 53 years that Medicaid has been around, there has never been a work requirement. MaryBeth Musumeci is the associate director at the Program on Medicaid and the Uninsured at the Kaiser Family Foundation.

MaryBeth Musumeci: In the over 50-year history of the program, no Democratic or Republican administration had ever allowed Medicaid benefits to be conditioned on meeting a work requirement. That changed in January 2018 when the Trump administration issued this guidance to states setting out how it planned to use its waiver authority to allow states to impose work requirements.

Amy Walter: Now, why had no other administration ever proposed this before?

MaryBeth Musumeci: It's not one of the eligibility criteria that Congress set out in the statute. You have to be a state resident, you have to meet certain income criteria. There are a number of things that you have to do to prove that you're eligible for Medicaid, but Medicaid is a health coverage program, and unlike other programs like TANF, which is the Federal Cash Assistance Benefit, where Congress has very clearly said one of those program purposes is to promote work, and that program in the statute does have a work requirement, that's not the case in Medicaid. That's just not part of the eligibility.

Amy Walter: In introducing this, what did the Trump administration give as a reason for allowing a state to require work?

MaryBeth Musumeci: The Trump administration is relying on what's known as a waiver authority. That is something that's in the law where Congress has said the Secretary of Health and Human Services has a certain amount of discretion to allow states to experiment. It has to be a demonstration program. You have to be piloting something. The purpose of the pilot needs to be furthering the purposes of the Medicaid program. There's authority that Congress gave to the Secretary to allow states some flexibility.

It's not boundless authority. It is hampered by these program purposes. The purposes that Congress spoke to in Medicaid are to provide medical assistance to low-income people, and then there's another provision to promote independence. That language has historically been read as supporting people with long-term care needs, like seniors and people with disabilities who need assistance with living independently in the community with long-term care. It has not, before, been interpreted as promoting or supporting work as part of the program.

Amy Walter: Can you help explain how this impacts two groups of people? One, people who are currently on Medicaid, and two, the people who may be in a state that hasn't expanded Medicaid, but is going to if they get this waiver.

MaryBeth Musumeci: It really depends on what the state has decided to ask for authority to do. For example, in Kentucky, Kentucky was an existing expansion, but it defines the population that's subject to its work requirement as both the expansion group as well as traditional Medicaid beneficiaries, so low-income parents, for example, who had been eligible before the Affordable Care Act. In other states like Arkansas, for example, its work requirement only applies to the expansion group who newly gained coverage under the Affordable Care Act and not to their traditional low-income parent population.

There's another group of states, however, and those are states that are asking for authority for work requirements who have not expanded and are not proposing to expand. These are states like Mississippi, Kansas, where eligibility limits for parents are quite low. We're talking 17%, 18% of the federal poverty level, and there's no coverage for childless adults as well. It's not like the state is saying, "We will expand if you let us impose a work requirement." They're saying, "In our existing population, we want those very low-income parents to work."

Amy Walter: What do we know about the people who are currently enrolled in Medicaid and their employment status? Are a majority of the people who are currently getting Medicaid not working?

MaryBeth Musumeci: No, actually, it's just exactly the opposite. Our data show that about 6 in 10 non elderly Medicaid adults are working, and about 80% are in working families. Then when you look at those who aren't working, most of them report some other reason that's a barrier to work, like an illness or a disability, or they report some other responsibility, like caregiving for someone else in the home or going to school. There's really only a very small share, about 7% of the non-elderly Medicaid adults that don't fall into one of those categories, either working themselves or caregiving, going to school, or having a disability.

Amy Walter: In your research, is there any evidence that either requiring a certain number of hours or requiring that they prove they're working a certain number of hours will have an impact on the number of people who can qualify for Medicaid?

MaryBeth Musumeci: By the states' own estimates, for example, Kentucky estimates that its waiver will result in about 95,000 people losing coverage. Now that's just not a result of the work requirement, but also a result of the premiums and the lockouts and the other provisions I mentioned. We've not had results in Medicaid before because we haven't had work requirements in Medicaid, but we can draw some lessons from the TANF program and the SNAP program, which have long-standing experience with work requirements. When you look at the impact in TANF, it shows that, again, most people already were working.

They're working in low-wage jobs. Those jobs typically don't offer health coverage or affordable health coverage, and the other big impact that the literature shows is that eligible people are at risk of losing coverage. That happens because people who are working also have to meet a reporting requirement. Every month, they're going to have to report and verify that they've met enough hours. Whenever you create a system like that, there's the potential for people to fall through the cracks, information to get misdirected, not handed off properly. That's one risk.

Another risk for the workers is the nature of work that low-income people tend to do. These aren't jobs that necessarily have steady hours week-in and week-out. A lot of times, people will not have control over their hours, not find out until the last minute what their hours will be. Maybe they're cobbling together two part-time jobs even though they'd like to work full-time. Meeting that hourly requirement consistently week-in-week-out, over the year also could be a challenge.

Then, finally, for the people who are exempted, the states define a number of exemptions. People who are what's called medically frail. They have some sort of physical or mental health reason that they shouldn't be working, people who are caregiving, people who are in school. There are a number of categories that states are saying, "We will exempt from the work requirement," but the reporting requirements still apply to those folks. They will also have to periodically-- First know that they are eligible for such an exemption and then be able to do whatever's needed to document or verify it to prove to the state that they are, in fact, exempt to keep their coverage.

That's something that the TANF studies have shown, that people who lost coverage were disproportionately people with disabilities who should have remained eligible because they just weren't able to navigate those systems.

Amy Walter: What impact did you think this is going to have on your average Medicaid recipient in one of these states? What would you tell someone who lives in that state who's currently getting Medicaid?

MaryBeth Musumeci: I think it's going to create a lot of confusion and it's going to create additional complexity both on behalf of the person who is receiving Medicaid to understand how to navigate this system, do the reporting, make sure they're getting all of their hours in or make sure their exemption status is approved each month, and also complexity on the part of the state. The states are building sophisticated IT systems to be able to do this tracking. The health plans are often involved in tracking.

There has to be a lot of information exchanged between providers, health plans, the state to make sure that each month someone is eligible and checking all of these boxes. It's additional administrative costs, and it's also putting people who remain eligible for the program, either because they are in fact working or they are in fact exempt, at risk of losing coverage if they get tripped up in this administrative process.

Amy Walter: MaryBeth Musumeci, associate director at the Program on Medicaid and the Uninsured at the Kaiser Family Foundation.

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Amy Walter: The president's executive order tying work requirements to Medicaid eligibility has shifted much of the fight to the states. Arkansas, last Tuesday, became the first state in the nation to require work in order to get Medicaid. On Thursday, lawmakers in Michigan passed similar legislation. Kentucky was granted a waiver for these work requirements, but a lawsuit challenging it is making its way through the courts. Meanwhile, last fall in Virginia, Democrats won the race for governor and made significant gains in the Legislature.

While Republicans still control the State House, the election was a wake-up call to many incumbents nervous about a potential blue wave ahead of this year's midterms. Before November, then Democratic Governor Terry McAuliffe pushed for but failed to get the Virginia Legislature to pass Medicaid expansion, but a combination of the fall election results and this new Medicaid waiver option helped push a Medicaid expansion bill through the legislature. Democratic Governor Ralph Northam signed it into law this week. Even traditionally Republican strongholds are seeing an opening to bring those federal dollars back home.

Senator Emmett Hanger: You'll find individuals even in our higher-income areas that are not at income levels where they can afford traditional health care insurance or access to health care.

Amy Walter: That's Virginia State Senator Emmett Hanger. He was one of four Republican lawmakers who broke ranks with his party to shepherd Medicaid expansion through the legislature. When I spoke with him recently, I asked him about why Republicans had, up until now, refused to consider expanding Medicaid.

Senator Emmett Hanger: There were numerous arguments. Most of them centered around the fact that they felt, "Well, there's a lot of uncertainty coming out of Washington. If we begin to do this, then the money goes away. How will we disenroll this large number of people that we've now made eligible?" There was also the argument, which I didn't subscribe to, which basically was, you're talking about insuring people that ought to be out there working and taking care of themselves. Again, I didn't subscribe to all of that because, in large part, there were some fallacies associated with that.

Amy Walter: What were some of the fallacies that you were hearing?

Senator Emmett Hanger: Sometimes, built into that are prejudices, if you will, against poor people, that say that, "Well, the reason why you're poor and can't afford your health insurance is because you're lazy or doing something you shouldn't be doing. That's just totally wrong. There are people that I've encountered all over this state, and we know well, that have circumstances, and it's one of those things that you can say, "But for the grace of God, there go I."

Amy Walter: When Obamacare first passed, was this an issue in your district, which is an overwhelmingly Republican district? I assume Obama did not carry the district.

Senator Emmett Hanger: No, no, no, he didn't show up. No, no.

Amy Walter: He didn't show up.

Senator Emmett Hanger: He was on the ballot, but very few people noticed it. No, it's a very Republican district. Actually, I've had a couple of primaries where, if you want to call them the hard right, the Tea Party, the activists associated with the Koch brothers, have attempted to defeat me in primaries.

Amy Walter: Why do you think you've been successful in fighting back these attacks in the primary?

Senator Emmett Hanger: We do a disservice to the people we represent if we allow a polarization, if you will, of our parties, where we end up representing our caucus, whether you're Republican or Democrat, or if we represent the extremes in either party, whether you're Republican or Democrat, rather than being able to actually become knowledgeable in what it is we're talking about, rather than going with wherever your caucus or your party thinks you should be, and then basically sharing that information and being a leader rather than a follower of what the public sentiment is at that time.

Amy Walter: Now, Virginia, you all just passed Medicaid expansion. What was this, a couple of weeks ago now?

Senator Emmett Hanger: Actually, the final passage was just a week ago. We had put together a compromise package that I was involved in negotiating with our House of Delegates and with the administration. What we attempted to do, and it actually worked, was to put legislation through that would go to the governor's desk that he, after review, was able to sign it without proposing any amendments.

Amy Walter: Tell us what was in that compromise legislation. My understanding of it is what got it through and got the support from other Republicans was a work requirement for the expansion of Medicaid. Is that fair?

Senator Emmett Hanger: That was one of the significant features in the House of Delegates, particularly, that they felt that that was important and that was built into the compromise, a work requirement for those that are able to work. Of course, there are a number of exemptions from that work requirement, but that really is one of the things that I'm excited about.

I think a number of individuals on the Democrat side of the aisle, when we go through exactly how we structured it, are getting very comfortable with this can be actually something that helps people, can help our economy, because it's structured in a way that really, as I view it, is more a hands-up to people rather than a punitive requirement.

Amy Walter: Let's talk about the idea that you can support people who may be struggling, and there's a reason that they may not be able to get a job, whether it is substance abuse, a disability, or they need job training. Isn't that going to cost a lot of money for the state?

Senator Emmett Hanger: Depends on how you go about it. There are models, and I guess I was disappointed that we waited as long as we did to take this step. Over the last four years, some have suggested that the amount of federal dollars that we could have brought to Virginia to help in this effort are in the range of $8 to $10 billion that we basically forfeited. The positive side of that is that we're able to learn from other states that have stepped out and tried to implement similar programs.

I think what we're going to end up with here is a program that's uniquely Virginia, that builds off of what they've been doing in Arkansas, Kentucky, Indiana, Washington, and other states that have implemented programs of this type.

Amy Walter: Do you worry that some of those people are just simply going to be unable to get the required number of hours they need, and ultimately, it's going to be impossible for them to ever hit that requirement?

Senator Emmett Hanger: There will be some, but we have flexibility built into the program, if there are circumstances where they have conditions that make it impractical for them to be in the job market, and we can address those, and we will. Certainly, as we implement this, we'll have those provisions in our regulations. You've got to make it, as I indicated, a hands-up rather than punitive. We're not going to set this thing up in a way that will just, "Okay, we got you. You're disqualified because you didn't show up for work Monday morning." If it's going to be successful, we've got to be able to provide the assistance that people need, the motivation that they need in order to make it successful.

Amy Walter: State Senator Hanger, thank you so much for joining us and explaining this to us.

Senator Emmett Hanger: I appreciate it, Amy. I appreciate your interest in the subject.

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Peter Muennig: Policy is usually made based on ideology rather than empirical science.

Amy Walter: That's Peter Muennig. He's a professor at Columbia University's Mailman School of Public Health, and you guessed it, he's a data guy. Professor Muennig has made a career of studying the impacts of public policy, including an experiment that took place from 1994 to 1999 called the Florida Family Transition Program. This was one program of many created to study and evaluate the transition from Aid to Families with Dependent Children to TANF, Temporary Assistance for Needy Families.

Peter Muennig: In this particular case, what they did was they would randomize people to just receive traditional welfare, or they would randomly assign them to a new idea in which people received welfare, but they received it for only five years, and in exchange for having the benefits cut off, they could work as much as they wanted and earn as much income as they wanted in that five years. The idea was to get people into the workforce.

Amy Walter: What did you learn from this trial?

Peter Muennig: It was actually consistent with all of the other studies across the nation, and with the actual implementation of the policy, it actually seemed to work on surface. When welfare recipients, and we should be clear about who we're talking about, these are usually single moms that are receiving welfare, whose partner has left them or who has passed away or for some other reason that their child doesn't have a father, and many of them also either have children with disabilities or themselves have disabilities, so they have physical or mental illness. Those are the recipients.

Even amongst this population, on average, the average person had increased earnings and increased employment, and they still got their welfare benefits. It was a win-win situation. At the end of the five years, the average person continued to have earnings and employment, and the welfare roles went down. It saved the government money, and it seemed to be good for the average recipient, but here's the twister. This is what you've been waiting for.

Amy Walter: Yes.

Peter Muennig: What we found was that everybody had their eye on the average. That was the ball that was in the air, but at the end of five years, as I said, these are mostly single moms, and many of them have a lot going on in their lives, including physical and mental illness. It actually turns out that a lot of women in these programs, or a lot of the recipients, were not able to work because they had major disability, a missing limb, a blindness, depression, schizophrenia, or children with severe illnesses, or many children that are hard to take care of.

At the end of five years, some never got a job and then didn't have their welfare benefits, and ended up homeless and on the streets, and died as a result of that. We found that mortality actually increased in the people amongst the group who seem to be receiving all these benefits.

Amy Walter: That was a lot of information there. Let's just break it down a minute. Here's what happened. The researchers took a pool of current welfare recipients and they broke them into two groups. One group was given five years to find a job. During those five years, while they were looking for work, they kept their benefits as a cushion during the transition. The other group wasn't required to find work, but they also couldn't supplement their welfare with outside earnings.

The result? For lots of folks in the Jobs Program, it really worked. They got jobs, many increased their earnings, and the state saw its welfare roles reduced. That's good news, but for the people who couldn't get jobs, they ended up in more dire straits. Their mortality rate was higher than those who were in the traditional welfare pool. On the one hand, you have more people who are able to find work, but for the ones who couldn't, it meant homelessness and even death. I asked Professor Muennig what happened to the other group, the group who were not required to find jobs.

Peter Muennig: They seemed to just go on as usual. This was a little bit of an unusual experiment in that, in Florida and actually in other sites, too, the control group was allowed to stay on traditional welfare even as Clinton had ended welfare as we know it, and the nation switched over to this new program based upon this evidence that had some flaws in reasoning, but they were able to stay on the traditional welfare program, and they just went on as usual, receiving welfare.

Their employment rates were lower, their earnings were lower, but they never ended up homeless. They never ended up dependent on other people. They never ended up in severe material hardship.

Amy Walter: What did policymakers decide to do with this information?

Peter Muennig: Nothing really so far.

Amy Walter: When you were done with this, what did you do with it? Where did it go?

Peter Muennig: I did what most academics do, which is I published it and then watched it disappear into the ether. It's interesting because this is the fate of most scientific studies, but it's interesting that even with this new evidence, that the nation has moved to work requirements. We're now talking about work requirements to get Medicaid, which is the group that is most likely to be disabled and most likely to be ill are people that are receiving Medicaid. It's being plugged into most other welfare programs.

I don't think that that's necessarily universally a bad thing. I think it's a great and noble idea to try and build a society in which everybody contributes, but you got to know what you're talking about. You got to know what the program is designed to do, who it's designed to work for, and who's going to be receiving benefits and who's going to be receiving harm from these programs. It actually turns out that people don't think about that. These programs seem to do more harm than good on average and cost more than they save.

Amy Walter: Professor Peter Muennig from Columbia University's Mailman School of Public Health.

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Amy Walter: Let's close it all out. Here's my takeaway. When government programs began in the 1930s, Americans were generally in agreement on who deserved to get support, widows, disabled people, children, but over time, that consensus over who is worthy of aid and who isn't has been lost. The challenge today is not only who deserves the aid, but whether and what they need to do to actually get it. Americans consider ourselves a very generous people.

We want to see people lifted from poverty, not trapped in it, but lots of us hate the idea that people are taking advantage of our generosity and mooching off a system that's already stressed to the brink. Of course, work in and of itself isn't enough to bring many people out of poverty, and as we learned from one of the researchers we interviewed, it can actually lead to terrible consequences for those who are already very vulnerable. Where does it all go from here? A lot of it will depend on, you guessed it, politics.

It's hard to believe that in these polarized times, Congress will be able to come to any consensus like they did back in 1996. Instead, it will fall to the president and his or her administration to keep or change the rules of the road for government welfare. Waivers that were granted one year may no longer be permitted under a new president. For people on government assistance, it means consistent uncertainty. That was my takeaway. What was Yours? Call us at 8778-Mytake or send us a tweet @thetakeaway or to me, @amyewalter. Thanks so much for being with us today. I'm Amy Walter. This is The Takeaway.

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