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Tarun Ramesh is an MD Candidate at Harvard Medical School, interested in health economics, rural health, substance use disorder prevention and addiction. He graduated summa cum laude from the University of Georgia with degrees in Economics and Genetics. His work on opioid use disorder, rural hospital closures, and provider consolidation have been published by the Center for American Progress, JAMA Health Forum, the Roosevelt Institute, the Georgia Political Review, and the Undergraduate Economic Review. He has previously worked for the Centers for Medicare and Medicaid Services and the Drug Policy Alliance.

Under the Personal Responsibility and Work Opportunity Act, Congress and President Bill Clinton devolved federal welfare assistance and granted states a wide latitude to implement the Temporary Assistance for Needy Families (TANF) program. The means-tested program offers states block grants to provide financial assistance and support services to eligible families. The stated goals of the program are to assist economically insecure families, end welfare dependence, reduce unmarried pregnancies, and encourage two-parent families. In 2018, states spent $31.3 billion on TANF programs, a majority ($16.6 billion) of which came from federal appropriations. 

However, states are authorized to distribute funds from their block grants based on state law, highlighting heterogeneous treatment for economically insecure families. The fixed monetary formulation of block grants leads to a large variation in the assistance provided to families. For example, families receive $318 per child in Texas, but a similar family would receive $3,220 per child in Vermont. Recipients must also meet inflexible work requirements laid out by state laws. Generally, a single parent must engage in 30 hours of work-related activities per week to remain beneficiaries of the program. 

Furthermore, state-led efforts to weaken the safety net have continued to exclude beneficiaries from receiving critical aid. Since the implementation of TANF, 15 states have passed legislation for drug testing or other screening for public assistance. For some of these states (e.g. Tennessee), ‘reasonable suspicion’ of a substance use disorder triggers a mandatory drug test, while other states (e.g. Georgia, Oklahoma) universally drug test recipients of public assistance prior to a 2014 court ruling that deemed universal drug testing unconstitutional. Strict eligibility criteria, including the use of drug testing or crime restrictions, for TANF exclude marginalized populations and prevents funds from reaching families. 

1) Drug testing TANF is costly with little benefit to state governments

A 2019 analysis by Think Progress found that of the 263,000 TANF applicants drug tested, only 338 people tested positive. In total, 13 states that codified drug testing for public assistance spent $200,000 for drug screening. Drug tests can cost from $35 to more than $200 each, while repeat testing and false positives can drive costs even higher. After the implementation of a universal testing law, Florida spent $118,140 in four months with a net cost of $45,780. Oklahoma’s ‘reasonable suspicion’ law cost $74,000 in the same time period, and an Idaho Department of Health and Welfare investigation found that a drug testing program to exclude recipients would not reduce state costs by an amount equal to the cost of administering drug testing requirements.  

2) Drug testing TANF stigmatizes individuals with substance use disorders

Excluding TANF recipients based on substance use disorders reinforces barriers to care for individuals with addiction. The American Society for Addiction Medicine has published extensive reports on how addiction is, and should be treated as, a chronic, psychiatric illness. Preventing individuals with a chronic disease from receiving public funds not only prevents individuals from receiving evidence-based treatment for their addiction but also criminalizes a public health issue. 

3) Drug testing confused drug use with drug dependence

Using the Women’s Employment Study and the National Household Survey of Drug Abuse, University of Michigan researchers found that while one-fifth surveyed reported illicit drug use only 5% had drug dependence diagnostic criteria. Considering that heroin and cocaine metabolites can be flushed out of the system within 72 hours, a positive drug test might divert necessary and finite resources away from individuals with addiction to infrequent drug users.

4) Universal drug testing for public assistance is unconstitutional

In multiple cases, federal courts have found that universal, mandatory drug testing for public assistance violates the Fourth amendment. In 2011, a US District Court in Lebron v. Wilkins vacated Georgia and Florida laws regarding universal drug testing citing that the “state has made no showing that it would be ‘impracticable’ to meet these prerequisites [reasonable suspicion or probable cause] in the context of TANF recipients.” District Courts in Florida and Michigan also vacated state laws that codified universal, mandatory drug testing for TANF recipients. 

5) Drug testing TANF disproportionately impacts families of color

Drug testing TANF recipients reinforces racist stereotypes for Black and Brown families, which are deeply rooted in institutional and systemic white supremacy. Strict policing of communities of color translates to the criminalization of individuals with addiction in marginalized populations. Furthermore, racially charged dog whistle terminology such as ‘welfare queen,’ represents institutional justification for excluding vulnerable communities from public goods and cutting funding to welfare programs such as TANF. Policies that exclude beneficiaries rather than improving aid to families should be unconditionally rejected.