Foundation for Government Accountability

Welfare reform

The Foundation for Government Accountability supports welfare reforms that promote individual responsibility and freedom, prioritize the truly needy, and reduce state and federal spending.

By studying and tracking the impact of different reforms, the FGA is able to give policy makers clear guidance on what welfare policies have a demonstrable effect on the incomes and independence of people on welfare. The FGA conducted the first and most comprehensive study^[4] of the impact of work requirements on able-bodied adults on food stamps in Kansas^[5] and Maine^[6] and found that incomes more than doubled within a year for those who transitioned out of the program. In all, for every $2,000 people on food stamps lost in benefits, they earned $3,000 in new income.

• Work Requirements: FGA supports expanding existing food stamp work requirements to more able-bodied adults, including parents with school-age children. This reform was included in the House-passed 2018 Farm Bill^[7]. FGA also supports work requirements as a condition of Medicaid eligibility for able-bodied adults, specifically in the Medicaid expansion population. To comply, qualifying, able-bodied individuals would be required to work, train, or volunteer at least 20 hours per week. Several states have sought waivers^[8] from the Centers for Medicare and Medicaid Services (CMS) to implement this reform.

• Medicaid Expansion: FGA advocates against Medicaid expansion^[9], arguing it puts the elderly, poor children, and those with disabilities at greater risk as resources are instead diverted to able-bodied adults. Blocking Medicaid expansion has been a longtime project of the FGA, as it sees Medicaid spending under the Affordable Care Act, or Obamacare, as unsustainable, threatening both state budgets and the services provided to traditional Medicaid patients.^[10] At the state level, Medicaid spending already crowds out funding^[11] for other critical services, such as primary and higher education, public safety, and infrastructure. A Harvard study^[12] found that the FGA’s involvement in this Medicaid debate was a key factor in whether or not a state expanded the program. The FGA was invited to discuss the merits and flaws of Medicaid expansion with former U.S. Secretary of Health and Human Services Kathleen Sebelius,^[13] who was in charge of implementing expansion under the Affordable Care Act.

• Stop the Scam: FGA supports measures that will improve welfare integrity by targeting welfare fraud and welfare policies that do not prioritize the truly needy. They support solutions that enable states to verify welfare enrollees’ eligibility, conduct continuing eligibility checks, and remove individuals who are abusing the system. Stop the Scam is a FGA program that partners states with third-party vendors to use the latest technology and databases to protect public programs like Medicare and Medicaid from fraud and abuse.^[14] State agencies are limited by federal law to how regularly they can audit their own rolls, and this partnership gives them a legal way to conduct more regular verifications. It also gives states access to far more databases than they are currently using or might have access to. This program was first run in Illinois^[15] and since has saved the programs hundreds of millions of dollars, removing 400,000 ineligible beneficiaries^[16] in the first two years.

Health Care Reform

FGA supports health care solutions that increase transparency and foster a free market.

• Right to Shop is a policy solution that allows patient to shop for health care services, which supporters argue allows consumers to receive high-quality, low-cost care. Maine implemented the reform in 2017^[17]. The FGA combined two successful programs (a Massachusetts price transparency component^[18] and New Hampshire's Smart Shopper program)^[19] into one comprehensive concept that allows patients to know the average price for their county from their insurer for specific services, and if they receive those services at a lower cost provider, the insurance company splits the savings with them in cash.^[20]
• Volunteer Care would allow medical professionals to more easily donate their services to needy individuals free of charge.

Freedom to Work

FGA supports state policies that remove barriers to work, specifically occupational licensing requirements, including fees and other barriers, for individuals leaving the prison system, low-income workers, and military families, among others. The organization also supports expanding apprenticeships as an alternative route to secure work.