Policy Expert Details Cruelty and Pointlessness of GOP's Medicaid Work Requirements

Days after Trump Cabinet officials championed work requirements in the pages of The New York Times, a progressive policy expert wrote in that same newspaper on Friday that such mandates—particularly for Medicaid recipients—are "cruel and pointless," potentially stripping critical benefits from millions of people through no fault of their own.

The GOP proposal, which advanced out of the House Energy and Commerce Committee earlier this week, would require many Medicaid recipients to prove that they worked or did some related activity for at least 80 hours per month. Republicans are also seeking to dramatically expand work requirements for recipients of federal nutrition assistance.

Matt Bruenig, founder of the People's Policy Project, a left-wing think tank, argued in his Times op-ed that "imposing work requirements on Medicaid is a fundamentally misguided policy," particularly given that "it is employers, not workers, who make hiring, firing, and scheduling decisions."

"Last year, over 20 million workers were laid off or fired at some point from their jobs," Bruenig observed. "Many of those workers ended up losing not just all of their income but also their employer-sponsored health care. Medicaid is supposed to provide a backstop for these workers, but if we tie eligibility to work, they will find themselves locked out of the healthcare system because of decisions their employers made, often for reasons beyond their control."

To underscore the absurdity of forcing vulnerable people to document adequate work hours in order to receive public benefits, Bruenig wrote that "our society could decide that police and fire departments will not respond to calls made by individuals who worked less than 80 hours in the prior month, but most would find this repugnant and contrary to the purpose of these services."

"Refusing medical care to people in their time of need based on how much they happened to work the month before is a cruel and pointless policy," he added.

"For those fundamentally opposed to Medicaid and the welfare state more generally, the fact that these new requirements would create administrative barriers that disenroll eligible recipients may be seen as a feature, not a bug."

Like other policy experts and healthcare advocates, Bruenig argued that Medicaid work requirements are a solution in search of a problem.

According to Bruenig's calculations, just 5% of Medicaid recipients are able-bodied adults without dependents who work fewer than 80 hours per month—a figure that undercuts the Republican narrative of a crisis-level refusal to work among single, adult Medicaid enrollees with no children.

Bruenig also notes the immense administrative burden that work requirements inevitably bring. "Requiring proof of monthly work hours will cause some people to lose coverage simply because they struggle to keep up with the paperwork, not just because they’re unemployed," he warned, echoing concerns expressed by other analysts.

The Center on Budget and Policy Priorities estimates that the GOP's proposed Medicaid work requirements would imperil benefits for more than 14 million people.

"For those fundamentally opposed to Medicaid and the welfare state more generally, the fact that these new requirements would create administrative barriers that disenroll eligible recipients may be seen as a feature, not a bug," Bruenig wrote. "I suspect that for many of the Republican policymakers who endorsed work requirements, the goal of such a policy isn't genuinely to increase employment or remove support from only those who refuse to work. Rather, it is to redirect resources from lower-income Americans toward those at the top. And for that purpose, it is indeed well designed."

Opponents of Medicaid work requirements typically point to Arkansas and Georgia as evidence that the mandates do little to boost employment while depriving many of health coverage.

The Washington Post reported Friday that in Georgia, "just 12,000 of the nearly 250,000 newly eligible Georgians ultimately received Medicaid" under the state's Pathways to Coverage program, which requires enrollees to submit monthly paperwork demonstrating that they worked, volunteered, or participated in job training for at least 80 hours.

"Some who do work had a tough time proving it to state officials—or their work, such as caring for ailing relatives, didn't qualify," the Post noted. "Georgia's experiences portend what's to come if work requirements are imposed nationally."

The work requirements that Republicans are pushing would produce roughly $300 billion in federal Medicaid spending cuts over the next decade—reductions that would be achieved by either removing people from the program or preventing people from enrolling.

U.S. Rep. Chip Roy (R-Texas) said Friday that he helped sink a vote to advance the GOP reconciliation package out of the House Budget Committee on Friday partly because the proposed Medicaid work requirements would begin in 2029, rather than immediately.