Work Requirements for Medicaid Imply a Federal Duty To Hire

Republicans in Congress are planning to slash funding for Medicaid in order to help pay for major tax reductions for wealthy Americans and corporations. But they don't want to cut Medicaid openly, because it will gravely injure many people who voted for them.

One way to cut Medicaid expenditures without overtly reducing benefits is to increase required paperwork. Additional bureaucratic hassle will discourage people from applying for what they are eligible for. The "big beautiful bill" currently discussed in Congress incorporates this strategy.

The major provision aimed at saving money requires Medicaid recipients to work at least 80 hours a month.

Until American conservatives wise up and emulate the conservatives in Taiwan, who introduced universal medical insurance there, we will have to live with a lot of unnecessary complexity and inflated administrative expense.

The work requirement requires frequent verification that a recipient is employed—more hassle. It will deny coverage to individuals who—for one reason or another—can't find work.

Given likely job loss due to artificial intelligence, mass corporate layoffs, and huge reductions in government payrolls, the number of people without insurance because they can't find work will likely be large.

This policy will be rather hard on people who through no fault of their own are unable to find work. And inability to get medical treatment may leave some people in such poor health that it makes it even harder to find and hold a job.

The work requirement, though, appears to be popular when people are polled. But many of the polled people may underestimate the danger that they themselves will lose their jobs, their job-related insurance, and their eligibility for Medicaid.

Fortunately, the bad consequences of the requirement could be completely eliminated by one simple additional government policy: that it will hire anybody who is otherwise unable to find work.

There is, of course, no end to the useful work that people employed by the government could do: elderly people who need help in their daily lives, children who could use tutoring, parks that need to be cleaned up, hiking trails that need maintenance, etc.

But guaranteeing jobs would cost the government (which is to say taxpayers) money, which would conflict with the desire to save money prompting Congress to restrict Medicaid eligibility in the first place.

And a guaranteed jobs policy, morally necessary in order to make federal medical policy less unjust, would also make public policy even more complicated than it already is.

A better solution to this problem would be to completely decouple medical insurance from employment. The United States is the only developed country that does not guarantee medical insurance for everyone, employed or unemployed, rich or poor, young or old.

Instead, we have a tremendously complicated system with different government programs for the old, for children, for Native Americans, for veterans, for the poor. As people's situations change, they can "churn" from one program to another, all too often falling into the gaps between programs, which leave them totally uncovered.

We'd all be better off, and would probably save money, if Congress wiped out all of today's complicated government insurance programs—including Obamacare, Medicare, and Medicaid—replacing them with a single program insuring everybody no matter their age or work status.

Unfortunately, American conservatives have been trained to reject a single-payer program like Medicare For All as "socialistic," without inquiring into the benefits such a program would produce. And enacting a major program like this would require bipartisan support.

Until American conservatives wise up and emulate the conservatives in Taiwan, who introduced universal medical insurance there, we will have to live with a lot of unnecessary complexity and inflated administrative expense.

Given this unpleasant fact, if Congress actually imposes a work requirement for Medicaid recipients, it should also enact a governmental program to employ anybody who is unable to find work elsewhere.

Since it is unlikely that Congress will do this, the best outcome we can realistically hope for is that the work requirement for Medicaid recipients will be stripped out of the bill in the Senate.