Who’s Able-Bodied, Anyway? (The New York Times)

Who’s Able-Bodied, Anyway?

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Who’s Able-Bodied Anyway?

The 400-year history of how we talk about the deserving versus the undeserving poor.

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CreditCristóbal Schmal

The “able-bodied” are now everywhere among government programs for the poor, Republican officials point out. They’re on food stamps. They’re collecting welfare. They’re living in subsidized housing. And their numbers have swelled on Medicaid, a program that critics say was never designed to serve them.

These so-called able-bodied are defined in many ways by what they are not: not disabled, not elderly, not children, not pregnant, not blind. They are effectively everyone left, and they have become the focus of resurgent conservative proposals to overhaul government aid, such as one announced last month by the Trump administration that would allow states to test work requirements for Medicaid.

Able-bodied is not truly a demographic label, though: There is no standard for physical or mental ability that makes a person able. Rather, the term has long been a political one. 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.

“Within that term is this entire history of debates about the poor who can work but refuse to, because they’re lazy,” said Susannah Ottaway, a historian of social welfare at Carleton College in Minnesota. “To a historian, to see this term is to understand its very close association with debates that center around the need to morally reform the poor.”

In Washington, “able-bodied” has retained its moral connotations but lost much of its historical context. The term dates back 400 years, when English lawmakers used it the same way, to separate poor people who were physically incapable of supporting themselves from the poor who ought to be able to. Debates over poverty in America today follow a direct line from that era.

“The basic point is that the physical distinction always implies a moral one, and that’s why politicians use it,” said Steve Hindle, the interim president and director of research at the Huntington Library in San Marino, Calif. He finds it not surprising but “profoundly sad” that so few politicians think about the lineage of the term.

Historians trace America’s welfare system to England’s 1601 poor law, which required local communities to collect taxes and distribute aid to the poor. But only the “impotent poor” — those truly powerless to support themselves — were to receive aid. The “able-bodied” were to be put to work.

Public debate about the poor, Mr. Hindle said, has centered ever since on a set of opposites: the deserving versus the undeserving, the idle versus the industrious, the able-bodied versus the old and sick. Over time, the English came to recognize a third class: the able-bodied who were blocked from work for reasons beyond their bodies, such as a shortage of available jobs. But even then, as today, structural problems and personal failings proved hard to separate.

Under Elizabethan poor law, the job of making these distinctions went to church wardens and parish overseers, people who lived in the community.

Today, we’ve constructed vast and expensive government bureaucracies to draw these lines. Kentucky, for instance, has outlined a number of exemptions to its new requirements that able-bodied Medicaid beneficiaries must work and pay small premiums. Former foster care youths and pregnant women don’t have to pay insurance premiums. The evicted and the homeless won’t be locked out from coverage if they miss their payments. People who are “medically frail” with serious ailments can postpone their work requirements with a doctor’s note.

Such exemptions sketch new definitions of who is truly able. And they erect more elaborate barriers to assistance as another way of winnowing out the unworthy. Eighteenth-century English overseers tried establishing rules (“nobody who tipples in the alehouse will get poor relief”). Requirements today that the poor take drug tests or pay $1 monthly premiums effectively do the same: “If you can’t figure out who is or isn’t deserving,” Ms. Ottaway wrote in an email, “then you can make rules about behavior that will force the poor to reveal themselves as worthy or not.”

By narrowing aid, proposals like Kentucky’s —
and Indiana’s Medicaid work requirement, approved Friday — reverse the more recent history in which Medicaid has steadily expanded access. The program began in 1965 with Elizabethan notions intact. It initially served the elderly poor, the blind and the disabled, as well as pregnant women. Over time it came to cover more parents and children. Eligibility was extended to poor women with breast or cervical cancer. In the 1990s, some states began offering coverage on a broader basis — simply according to income.

In 2010, the Affordable Care Act sought to make that policy experiment universal. It required all states to expand coverage to everyone earning below or just above the poverty line. (The Supreme Court later made the change optional, so now 32 states and the District of Columbia have chosen to expand.) Millions of nondisabled adults have joined the program in recent years, driving down the rate of Americans without health insurance and increasing Medicaid’s ranks.

“It’s a clear sequence from 1965 to 2010, where ‘able-bodiedness,’ ‘worthy poor’ is being written out of the statute,” said Leonardo Cuello, the health policy director at the National Health Law Program, a legal advocacy group that is bringing a lawsuit against the Kentucky Medicaid proposal. “And that comes to its full completion in 2010, where able-bodiedness is explicitly irrelevant.”

For Medicaid advocates like Mr. Cuello, the recent focus on the able-bodied feels like an anachronism.

To others who use the term, it captures how Americans of both parties feel about poverty today. In one 2016 survey by the American Enterprise Institute and The Los Angeles Times, 87 percent of people said it’s better to require people to seek work or participate in a training program “if they are physically able to do so” (9 percent countered that it’s better to give the poor benefits “without asking for any effort in return”).

“Free riders threaten society — they undermine the basis of altruism,” said Robert Rector, a senior research fellow at the conservative Heritage Foundation, 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.”

Robert Doar, a scholar at the conservative-leaning American Enterprise Institute, suggests that conservatives are also less likely to write off the poor as unable to contribute, or to dismiss entry-level jobs as dead ends.

“The barriers that prevent people from going to work are real,” said Mr. Doar, who served as an administrator of social services in New York State and in the administration of Mayor Michael Bloomberg in New York City. “But if you start from the premise that those barriers are insurmountable, I think you really won’t be helping people escape poverty.”

Just five years ago, Cindy Mann, who ran Medicaid in the Obama administration and is now a partner at the consultancy Manatt Health, said she seldom heard the term able-bodied in connection with Medicaid. Its ubiquity today — in news conferences from the White House podium, in think tank reports, in news articles — suggests that its adherents have been effective in an important way. “Able-bodied” has lately come to feel technical, not ideological; objective, not judgmental. This language has nudged its way into how many people, not just House Speaker Paul Ryan, speak.

And despite our borrowing it from Elizabethan England, its assumptions feel deeply American.

“To me, there is something about this that gets right to the heart of a lot of central myths about America,” said Sarah Handley-Cousins, a historian who has written about nearly identical debates over who deserved pensions after the Civil War. Americans pull themselves up by their bootstraps. Work is a moral endeavor. Those who work hard get ahead. “And people get very suspicious and get very angry,” Ms. Handley-Cousin said, “about the idea that some people aren’t doing that.”

Absent all its context, however, “able-bodied” is an odd term for an era when so much work isn’t physical in nature. Today, a blind person who is categorically eligible for aid could well do work that a person with depression — and who is “able-bodied” — could not.

And this part is most curious: While these words were explicitly cited in the legislation that established Elizabethan poor law, they barely exist in the statutes and guidelines governing American aid today. The food stamp program does identify a group called “able-bodied adults without dependents.” But Medicaid makes no mention of them.

“It has no basis in the law or the program,” Ms. Mann said. “I think it’s a political term, and I think it’s used pejoratively, and I think it’s quite intentional when it’s used.”

It’s used, she says, to imply that the newest group of people who receive Medicaid don’t deserve it.

Emily Badger writes about cities and urban policy for The Upshot from the San Francisco bureau. She’s particularly interested in housing, transportation and inequality — and how they’re all connected. She joined the Times in 2016 from The Washington Post. @emilymbadger

Margot Sanger-Katz is a domestic correspondent and writes about health care for The Upshot. She was previously a reporter at National Journal and The Concord Monitor and an editor at Legal Affairs and the Yale Alumni Magazine. @sangerkatzFacebook

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February 5, 2018 at 08:05AM