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arkansas
Want to See Why the GOP Medicaid Work Requirements Are a Disaster? Look to Arkansas
Wishful thinking and wildly unrealistic assumptions will not magically make a horrible policy a good one.
Jul 02, 2026
As I noted in an article earlier this month, the Congressional Budget Office (CBO) estimates that the federal government will save $911 billion over 10 years and that 10 million people will lose health insurance as a result of Medicaid changes in H.R.1, aka the One Big Beautiful Bill Act (OBBBA). This bill requires near-poor, able-bodied Medicaid beneficiaries with incomes currently above the poverty line but under thresholds that depend on family size — $22,025 for an individual or $45,360 for a family of four — to navigate a maze of red tape and reporting requirements twice a year to remain enrolled. Disabled people on Medicaid, including those with cancer or end stage renal disease, will have to prove that they are too disabled to work in order to waive the work requirement.
An analysis by health policy organization KFF found that in 2023, 64 percent of adults 19 to 64 years of age enrolled in Medicaid were working either full or part-time. Nearly 30 percent were not working because of caregiving responsibilities, disability or school attendance — barriers to employment that typically exempt people from work requirements in programs that mandate them. Most of the 8 percent who were not working were retired or unemployed. The result is that only a small share of Medicaid enrollees will lose access to the program because they do not meet work requirements. However, many more will lose coverage because of the difficulty of navigating the reporting requirements and the administrative red tape built into the OBBBA for this purpose.
In June 2026, HHS released interim regulations for the changes to Medicaid that states must implement by January 1, 2027. The regulations are much more severe than the requirements in H.R.1, and have upended work that states had already done to be ready to comply by the January 1 deadline. This has forced states to scramble to be ready in just six months, an extraordinarily short window to prepare for the large changes in reporting requirements. Disenrolling people by mistake may mean the difference between life and death for Medicaid enrollees. The rollout of the new work and massively burdensome reporting requirements is likely to be bumpy.
ASPE Publishes Very Brief Fantastical Briefing Report
In conjunction with the release of the new eligibility and reporting requirements, the Department of Health and Human Services released a brief, prepared by the Office of the Assistant Secretary for Planning and Evaluation (ASPE), with the Orwellian title, “Medicaid Work Requirements Incentivize Employment and Are Estimated to Reduce Poverty.” The brief’s conclusion that pushing people off the Medicaid rolls will increase employment and reduce poverty is contradicted by an earlier assessment by the Congressional Budget Office (CBO). CBO found that mandating work requirements would decrease what the federal government pays for Medicaid, increase the number of people without health insurance, raise costs for states, and wouldn’t increase employment.
The four-and-a half page ASPE brief has few citations for its assertions about how cutting access to health insurance for poor people will magically produce jobs for those disenrolled from Medicaid. While the authors say they have reviewed three decades of literature on work requirements in social programs, and they have an online bibliography with more than 130 references, they cite only 10 papers in the brief. As NOTUS observes, the researchers that produced the 10 papers cited in the brief are crying foul, claiming that their studies are being misused, and in some cases are being used to support conclusions that are the opposite of what the studies show. In other cases, researchers complain that while the findings of their studies may not be distorted, crucial job search supports for job seekers in their studies that are not available to people facing disenrollment from Medicaid in 2027 are ignored in the ASPE brief.
As noted in a technical analysis of the ASPE brief published in Health Affairs, the brief assumes totally unrealistic employment effects. It considers two scenarios. In the first, all 5.8 million people on Medicaid — who the brief assumes will not meet the new work requirements and are not exempt from them — will increase their work effort. The report does not spell out where the 5.8 million figure comes from, but a back-of-the-envelope calculation suggests it includes about 4.2 million people enrolled in Medicaid who are working part-time and 1.6 million who are retired, unemployed or otherwise not working. The brief assumes that these Medicaid recipients will increase their hours of work at their current wage or at the average wage among similarly educated Medicaid-eligible individuals.
Part-time workers are assumed to increase their hours and those who are not working are assumed to find jobs. Unbelievably, the change in employment participation is assumed to be 100 percent in the first scenario. This is more than 23 times higher than the 4.2 percent increase the ASPE brief authors report for welfare-to-work experiments that, unlike Medicaid work requirements, involved cash assistance and provided people leaving welfare programs with substantial help for finding work.The help included employment services such as transportation and job search assistance and case management services to assist people in meeting work requirements. In the second scenario, the brief’s authors assume that 80 percent of the 5.8 million people they believe will not meet the work requirements will succeed in finding employment. This is a 57 percent increase in participation and is 13 times the welfare-to-work effect.
The reductions in poverty cited in the ASPE brief are not calculated independently, but follow from the entirely unrealistic assumptions about the increases in work participation. The earnings increase on average per family is $16,780 — a result of the built-in employment and wage assumptions. Net of the loss of benefits as their incomes rose, families of Medicaid recipients whose work participation rises experience an increase in resources or $12,034. In the first scenario, this reduces poverty by 2.9 million people; in the second, by 1.6 million.
Arkansas’ Experience with Work Requirements
The ASPE brief omits any mention of the one instance where a state — Arkansas — implemented work requirements in 2018. This is a glaring omission in a report on the effects of work requirements in Medicaid, and suggests the brief’s authors may not have wanted to report the disastrous results of this introduction of work requirements.
The application of work requirements to Medicaid is a new development and there are just a few empirical studies of the Arkansas case. A cutting edge 2026 analysis by Harvard Medical School researcher Yuji Mizushima found that total Medicaid participation declined sharply during the months in which the mandated work requirements were in effect. Mizushima examined two groups of people — those on Medicaid who were disenrolled because they didn’t meet the work requirement, and those in the general population who failed to enroll in Medicaid because of the work requirement. The author found that participation in Medicaid fell by about 28,810 adults — 18,164 who were disenrolled and more than 10,500 who did not apply or reapply for Medicaid. There was no discernible change in the number of hours worked and no increase in employment or in participation in the labor force of the Medicaid population in the months leading up to, during, or following the enforcement of the work mandate. This supports similar findings in research on the Arkansas experience in other studies. A year after Arkansas implemented work requirements, the poor results led a federal judge to pause and later to strike down the work requirement.
Conclusion
The introduction of work requirements in Medicaid in Arkansas during the first Trump administration led to a disastrous decline in access to health insurance for people who had relied on Medicaid for health care, but did not increase hours of work or employment. This stands in direct contradiction to the wishful thinking and wildly unrealistic assumptions embodied in the two scenarios in the ASPE brief, and raises unavoidable questions about why the authors failed to examine the Arkansas experience.
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Report Details a Doubling of GOP-Led Attacks on Democracy in 2025
"While citizens are rightfully focused on the horror unfolding in Washington, extremist politicians are taking advantage of the moment," said the head of the Fairness Project.
Sep 10, 2025
As Missouri House Republicans on Tuesday advanced a congressional map rigged for the GOP and new limits for citizen initiative petitions, an advocacy group that promotes progressive policies via direct democracy revealed that "extremist" legislators across the United States "escalated their efforts to dismantle the ballot measure process in 2025 by 95%."
The Fairness Project has "won 39 ballot measures to raise wages, protect abortion rights, stop predatory payday lenders, expand healthcare access, secure more paid time off, and other life-changing policies for more than 23 million people." The group's new report, Direct Democracy Under Assault, details recent GOP moves to thwart such progress.
"During the 2023 legislative session, 76 bills were introduced that would restrict or undermine the ballot initiative process, which was until then the highest number on record," according to the report. "For further perspective, only 33 ballot measure attack bills were tracked in 2017, and a grand total of 377 bills attacking ballot measure processes were proposed by state legislatures in the 23-year span between 2000 and 2023. To see 148 in a single year, 2025, is an extreme acceleration."
"Lawmakers have not just been toying with the idea of undermining ballot measure processes; they've been passing these attacks into law," the publication emphasizes. "As of June 2025, 51 bills altering the ballot measure process had already passed state houses. For comparison, the annual average of enacted attacks on direct democracy between 2018 and 2023 was 34 enacted bills. Once again, 2025 is a troubling outlier."
"The erosion of our democracy isn't just happening in the Oval Office; it's happening in our home states when politicians attack the ballot measure process."
This year's GOP-led efforts to limit direct democracy at the state level come as Republican US President Donald Trump has returned to power and swiftly engaged in various attacks on democracy, from gutting the federal government—including the voting rights unit at the Department of Justice—to issuing a series of unconstitutional executive orders.
"While citizens are rightfully focused on the horror unfolding in Washington, extremist politicians are taking advantage of the moment and attacking the most powerful tools voters have at their disposal to make their voices heard," said Kelly Hall, the Fairness Project's executive director. "The erosion of our democracy isn't just happening in the Oval Office; it's happening in our home states when politicians attack the ballot measure process and replace the will of the voters with their own political agendas."
State legislators have pursued a range of attacks on the ballot measure process. The report notes that "one common tactic—used in states like Ohio, Missouri, Florida, Arizona, and Arkansas—is raising the threshold for passage to a supermajority, making it harder for citizen-led initiatives to succeed."
"Other strategies include increasing signature requirements, imposing strict rules on how and where signatures can be gathered, limiting what issues a ballot measure can address, and imposing high costs on advocates attempting to use their direct democracy rights," the document continues.
Hall stressed that "this isn't reform; it's a calculated effort to strip voters of their constitutional right to shape policy."
While the project tracked bills across 15 states, the report gives special attention to eight "where especially aggressive efforts threaten to significantly erode voters' access to direct democracy." They are Arkansas, Florida, Missouri, Montana, North Dakota, Oklahoma, South Dakota, and Utah.
In Arkansas, for example, during the 2025 legislative session alone, state lawmakers imposed burdensome rules on local initiatives, "criminalized small mistakes," passed restrictions on ballot language, gave the attorney general veto power over petitions, and more. The report says that "taken together, these laws represent a coordinated and deeply undemocratic
effort to strip power from Arkansas voters and insulate elected officials from direct public accountability."
The League of Women Voters of Arkansas is fighting back, and in April filed a federal lawsuit against eight new laws that David Couch, the plaintiffs' lead attorney, said "weaponize bureaucracy to suppress citizen participation and violate the fundamental rights guaranteed by both the Arkansas and US Constitutions."
There's also litigation in Florida and Oklahoma, while in North Dakota, South Dakota, and Utah, voters will decide next year whether to raise the threshold for future constitutional amendments or citizen-initiated ballot measures from a simple majority to 60%.
"Every voter should be alarmed that politicians are systematically taking away our rights to make change through the ballot," said Hall. "This isn't a time to back down—in fact, these cowardly attacks only underscore the urgent need to defend ballot measures and, by extension, defend our democracy."
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GOP AGs Urge Congress to Crack Down on Shield Laws and Telehealth Abortions
The Republican coalition targeted California and New York, both home to doctors who have been targeted by legal cases for allegedly providing abortion pills to patients in states with strict bans.
Jul 30, 2025
While a recently filed lawsuit in Texas jeopardizes the future of telehealth abortions, some Republican state attorneys general don't want the GOP-controlled Congress to wait for the results of that case, and this week urged leaders on Capitol Hill to consider passing federal legislation that would restrict doctors from shipping pills to patients to end their pregnancies.
Since the U.S. Supreme Court's right-wing majority ended nationwide abortion rights with Dobbs v. Jackson Women's Health Organization three years ago, anti-choice state lawmakers have ramped up efforts to restrict reproductive freedom. At the same time, some Democratic officials have enacted "shield laws" to protect in-state providers and traveling patients.
Led by Arkansas Attorney General Tim Griffin, 16 state AGs on Tuesday wrote to top congressional leaders from both parties, calling on them to "assess the constitutional authority it may have to preempt shield laws."
Griffin also sent cease-and-desist letters to two entities shipping abortion medication within the United States and two website companies that provide services to LifeOnEasyPills.org. Reporting on the AG's press conference, South Carolina Daily Gazette noted that "if the entities don't cease advertising abortion pills in Arkansas, Griffin said his office may bring a lawsuit against them for violating the state's deceptive trade practices law."
While Griffin also "said he believes what he is asking lawmakers to do is different from a federal abortion ban that the closely divided Congress has seemed hesitant to tackle," according to the Daily Gazette, advocates for reproductive rights disagreed.
Responding to the letter to Congress on social media, the advocacy group Reproductive Freedom for All shared a petition opposing a national abortion ban. It says that Republican President Donald Trump "has proven time and time again that he is out of touch with the 8 in 10 Americans who support protecting abortion rights."
"On the campaign trail he spewed whatever lies he could to get him reelected. Now he'll use the Project 2025 playbook to further restrict our right to access abortion, contraception, fertility treatments, and more," the petition warns. "We must stop him."
Yesterday, 16 Republican attorneys general sent a letter to congressional leadership urging them to override state telemedicine abortion shield laws.Sign the petition below to stand up to Republican lawmakers!act.reproductivefreedomforall.org/a/no-nationa...
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— Reproductive Freedom for All (@reproductivefreedomforall.org) July 30, 2025 at 3:48 PM
In addition to Griffin, the Tuesday letter is signed by the attorneys general of Alabama, Florida, Idaho, Indiana, Iowa, Kansas, Louisiana, Missouri, Nebraska, Oklahoma, South Carolina, South Dakota, Texas, West Virginia, and Wyoming.
The GOP coalition targeted two states, arguing that "when New York or California refuses to respect a criminal prosecution or a civil judgment against an individual who is accused of violating the abortion laws of another state, they are refusing to give full faith and credit to that state's judicial proceedings."
Last December, Texas Attorney General Ken Paxton announced a first-of-its-kind lawsuit against a provider in New York. He sued Dr. Margaret Daley Carpenter, co-founder of the Abortion Coalition for Telemedicine (ACT), for providing two drugs used in medication abortions—mifepristone and misoprostol—to a 20-year-old resident of Collin County.
In February, on the same day that Texas State District Judge Bryan Gantt ordered Carpenter to pay over $100,000 in fines and fees, Louisiana Attorney General Liz Murrill sought to extradite the ACT doctor. Her state classifies mifepristone and misoprostol as dangerous controlled substances.
While Republican Louisiana Gov. Jeff Landry signed the extradition warrant sought by Murrill and the district attorney, New York is one of nearly two dozen states with shield laws for reproductive healthcare, and its Democratic governor, Kathy Hochul, said that "I will not be signing an extradition order that came from the governor of Louisiana—not now, not ever."
On Monday, Paxton took legal action against Taylor Brucka, the clerk in Ulster County, New York, for refusing to make Carpenter pay the $100,000 penalty. Bruck told The Guardian that "it's really unprecedented for a clerk to be in this position" and "I'm just proud to live in a state that has something like the shield law here to protect our healthcare providers from out-of-state proceedings like this."
Meanwhile, another case involving a California doctor emerged in Texas earlier this month: A man filed a wrongful death lawsuit against Dr. Rémy Coeytaux for allegedly mailing to Galveston County medication that his girlfriend used to end her pregnancy. His lawyer is Jonathan Mitchell, an "anti-abortion legal terrorist" who previously served as the state's solicitor general and was the chief architect of its law that entices anti-choice vigilantes with $10,000 bounties to enforce a six-week ban.
Mary Ziegler, an abortion historian and law professor at the University of California, Davis, recently told Mother Jones that "the whole game for Jonathan Mitchell is to get into federal court... both because he wants to shut down doctors in shield law states, like everyone in the anti-abortion movement, and because he wants a federal court to weigh in on the Comstock Act," a dormant 1873 law that criminalized the shipping of "obscene" materials, including abortifacients.
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