Americans, as French political scientist Alexis de Tocqueville observed in 1831, have a special propensity for coming together outside of government as volunteers for community improvement. From Benjamin Franklin’s organization of the nation’s first volunteer fire brigade to President George H. W. Bush’s 1989 call for Americans to volunteer as a “thousand points of light,” we are a people who often just simply go out and contribute our time when we identify a need or problem for our neighbor or in our community.
Of course, not all problems are solvable with volunteer help and the miracles of modern health care are the foremost example. When lifesaving cancer care can easily cost hundreds of thousands of dollars, a society that values every person needs to figure out how to develop systems to provide that care for those who get sick. And while 75% of fire fighters are still volunteers, especially in rural areas, government steps in to pay for the expensive (And much more effective than Franklin’s buckets!) equipment used today.
Stepping into the volunteer issue, a new law (H.R. 1) passed by Congress last year links Medicaid and work/volunteer reporting requirements – and this along other with other changes are estimated to increase the number of uninsured Americans by 10 million people through 2034. My colleague Leonardo Cuello has been detailing paperwork problems with the execution of this idea for years – see here. But adding to these problems, H.R. 1’s treatment of volunteer work exemplifies the issues that ensue when government gets involved in trying to tell Americans how, where and when to volunteer.
A key section of H.R. 1 links continuing Medicaid coverage not just to meeting work reporting requirements every month but also allows reporting of “community engagement” or volunteer work to count as well towards maintaining one’s Medicaid coverage. The proposed federal rule implementing H.R. 1’s reporting requirements is quite clear that some volunteer work simply won’t count in the government’s view. Only volunteer work in a “structured program” completed under the “auspices of a public or nonprofit organizations” where the organization has “a process in place to track the community service…including the type of community service activity, dates and hours the community service is complete, and a point of contact who can confirm the hours completed.” So, helping an elderly neighbor with yard work or helping an informal community group without the means or ability to track volunteer hours do a neighborhood cleanup both wouldn’t count. [See proposed Sec 435.552(b)].
The problem with coupling volunteer work that Americans overwhelmingly engage in to the basic benefit of state/federal Medicaid coverage goes right back to de Tocqueville’s insights. While people often quote his thoughts on American’s unique power of community association and volunteerism, they often forget de Tocqueville’s related insight about the danger of government’s involvement in the same work:
A government can no more suffice on its own to maintain and renew the circulation of sentiments and ideas in a great people than to conduct all its industrial undertakings. As soon as it tries to leave the political sphere to project itself on this new track, it will exercise an insupportable tyranny even without wishing to; for a government knows only how to dictate precise rules; it imposes the sentiments and the ideas that it favors, and it is always hard to distinguish its counsels from its orders.
President Bush understood the importance of independent American volunteerism too – in his speech calling on Americans to volunteer he was clear that, “government can only do so much – and should only attempt so much.” Not only that, but in giving out his first “points of light” awards for volunteerism he emphasized the importance of how “a neighbor can help a neighbor.”
You don’t have to agree with de Tocqueville or Bush on everything to see the problems of government getting involved in how Americans volunteer through the new requirements in H.R. 1. Under these new federal rules, keep your health coverage, but only if you satisfy government reporting of work or volunteer hours in structured program with a process to track hours, a point of contact, and more in an organization certified by the state as meeting these requirements.
What more “insupportable tyranny” than the government deciding some volunteer work is more legitimate than other volunteer work, at least if you want to keep your health coverage? Even Franklin’s association wouldn’t count under the new rules – the original documents forming Franklin’s volunteer fire brigade don’t include a timesheet and hour tracking system – just a requirement to come to a monthly meeting and be ready to fight fires. And President’s Bush’s localized call for neighbors to help neighbors wouldn’t presumably be enough either.
More paperwork usually leads to more problems – but the government’s attempt to regulate and define what constitutes “community engagement” reveals a more basic misunderstanding of the importance of volunteer work for all Americans. In my view, getting treatment for cancer or a broken arm shouldn’t depend on filing arcane work hour reporting paperwork or meeting the government’s definition of what constitutes the “right kind” of volunteer labor. But since Congress passed H.R. 1 to require this, why implement new rules that disqualify volunteer work that Americans have routinely done since before we even became an independent nation?