Blog post considers how we talk about the ‘deserving’ vs. ‘undeserving’ poor

Joanne Kenen

About Joanne Kenen

Joanne Kenen, (@JoanneKenen) the health editor at Politico, is AHCJ’s topic leader on health reform and curates related material at She welcomes questions and suggestions on health reform resources and tip sheets at Follow her on Facebook.

Photo: Manar Hussain via Flickr

Medicaid work requirements going into effect in at least a handful of states will only affect the “able-bodied.” But precisely what does that mean?

Emily Badger and Margot Sanger-Katz unpack that term, as well as “deserving poor.” They say in“Who’s Able-Bodied Anyway?” for The New York Times’ Upshot blog, that the “able-bodied” are defined by what they are not – “ not disabled, not elderly, not children, not pregnant, not blind.”

Even so, this is a mushy label – more political than scientific. “Across centuries of use, it has consistently implied another negative: The able-bodied could work, but are not working (or working hard enough). And, as such, they don’t deserve our aid,” Badger and Sanger-Katz write.

That encapsulates a decades-long debate – one could argue centuries-long – about the “deserving” or the “undeserving” poor. And the new Medicaid work rules, still being fleshed out, may embody such judgments. It goes to a fundamental debate both about health care (Is it a right? Our country’s politics strongly suggest we have not agreed as a nation that it is.) and about Medicaid (Is it a health program, or, as many leading Republicans would argue now, is it a welfare program?). The ACA, with its Medicaid expansion to just above the poverty line regardless of how “able-bodied” they were, or whether they had dependents, clearly saw it as a health coverage program. That is not the view in D.C. now.

Badger and Sanger-Katz quote a researcher at the conservative Heritage Foundation researcher on this point.

“Free riders threaten society — they undermine the basis of altruism,” said Robert Rector, a Heritage senior research fellow who helped write a work requirement into welfare reform in the 1990s. That’s not a liberal or conservative belief, he argues, but a human one. “People want to be compassionate, but they don’t want to be taken advantage of.”

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