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Republicans Begin Work On Overhauling Entitlement Programs


President Trump and congressional Republicans have said now that they've gotten their tax bill through, the next priority is to overhaul entitlement programs. And we are seeing the first steps in that. Yesterday, the Trump administration announced it will allow some states to require Medicaid recipients to get a job. Jeff Colyer is the lieutenant governor of Kansas, one of the states that supports the idea of implementing this kind of work requirement. He's also a practicing physician, and he joins me now. Lieutenant Governor, thanks so much for being with us.

JEFF COLYER: Good morning.

MARTIN: So you like this idea of requiring Medicaid recipients to work, explain why.

COLYER: The health benefits of work are very obvious. You're going to have lower rates of depression, for example. It gives you an opportunity to work, to have somebody else involved with your life so that we make sure that you're taking your medications and that you have better general health. There's a lot of data that suggests that this can be a very protective effect.

MARTIN: So this is supposed to be for able-bodied people only. Those are the ones who are supposed to be required to get a job under this. But what if people don't have a physical disability but an intellectual one, would this apply to them?

COLYER: No, it would not apply to people with intellectual disabilities. For example, in Kansas, we are - of the 430,000 Kansans that are on Medicaid, this would apply to about 12,000 people. What we're talking about is using this only for able-bodied adults. But if you're a pregnant mother, if you're a child, if you're somebody that has a disability or if you're somebody that has a substance abuse disorder and you're receiving treatment for that, we certainly wouldn't require you to work.

MARTIN: So it seems to me that the art in this is going to be able to discern who is able-bodied and who is not. How do you make those choices?

COLYER: Well, we make those choices in a lot of different programs as well such as Welfare to Work and in - which is called TANF. We also do that with the food stamp programs. And it is something where the states can work very closely and very individually. In our Medicaid program, where we work very closely on these different types of programs, they are called waivers. And individuals, say, that are in the developmental disability waiver are not required to work in this. We're talking about only able-bodied adults.

MARTIN: So you are confident that no one's going to fall through the cracks here, that no one who is physically disabled or mentally unable to work will be deprived of benefits or forced to get a job unnecessarily?

COLYER: Oh, no. And there is also a process that people can appeal, you know, these issues with it. It also gives people an opportunity to sign up for additional programs. So what you can do is you can actually go and have additional work training. You can have apprenticeships. You can work in a variety of different options in your community. If there's a community where there may be a special volunteer situation, you can work with them. If you have a disabled person at home that you're helping with, you're not going to be forced to work. We want you to work with your child, with your family member.

MARTIN: So you're taking that in consideration, people who are full-time caregivers?

COLYER: Oh, absolutely.

MARTIN: Is - do you get the sense that there are a lot of Kansans who are out there gaming the system and living off Medicaid money on unnecessarily? I mean, why does this change need to happen?

COLYER: What this does is it promotes health benefits for people. I think when we look at an individual and we're trying to help them, we're trying to help them to independence. And so there are a lot of different programs that are available to somebody such as work training and health care and different educational benefits.

MARTIN: But critics would say that in order - that the order's reversed here, that you should have - you should secure health care for someone before they can actually get a job. Otherwise, is there a chance they might get sicker?

COLYER: Oh, no. People that are sick are, of course, going to be excluded from this. There are certainly exemptions, you know, that if, you know, let's say you had a serious cancer. Of course we wouldn't do that. It's not that it's backwards. What we're trying to talk about is only people who are able to work. And we're going to - when the results of this - when we see this in our other programs, we're seeing their incomes increase 240 percent over the next couple of years.

MARTIN: OK. This is something we are going to continue to look into. Thank you so much for joining us. Jeff Colyer, lieutenant governor of Kansas. Transcript provided by NPR, Copyright NPR.