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Work Requirements for Medicaid Imply a Federal Duty To Hire
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.
Jun 12, 2025
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.
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A National Single-Payer Healthcare System Would Be Good for Employers, Too
Job-based insurance poses health-related and financial burdens on company employers and employees. These burdens would disappear with universal healthcare.
May 17, 2025
The National Day of Action is set for May 31, 2025, as a call to action in communities across the United States. The goal is to unite people locally and nationally to eliminate profit-based healthcare. This nonviolent campaign is a collective effort that aims to put National Single Payer on the national agenda. Everyone has a basic human right to healthcare.
This opinion piece shares research findings to advocate for a single-payer healthcare system. Among wealthy countries, the U.S. has by far the most expensive healthcare system, and yet the only one without universal coverage. It is fundamentally broken. The system is inequitable due to differences in insurance availability based on work status, income, and other factors. Individuals of different backgrounds don’t have the same level of access to quality healthcare services. Excess administrative costs for insurers and providers add to an estimate of $504 billion out of $1.1 trillion. The time that it takes providers to complete billing tasks can compromise patient-provider relationships and care delivery.
Employer-sponsored insurance plans are the mainstay of U.S. health insurance. More than 156 million Americans (workers and their families) are covered by job-based insurance. The plans can incur high costs for employees and their families. It also places a burden on employers, including premium payments, time spent managing insurance, and potential compromises to hiring and worker productivity. One study estimated annual transactions costs to companies of $21.6 billion. Time spent by employees dealing with insurance issues may constitute the “sludge” that reduces productivity.
“All my employees are friends of mine. It really pains me to see them not go to the doctor, especially for specialists.”
Researchers at the University of California, Berkeley and the University of California, San Francisco studied the consequences of the U.S. system of health insurance on employers. We conducted seven company case studies, with companies in various industries and of varying sizes. Companies were qualitatively and quantitatively explored for the burdens imposed on employers by providing health insurance to their workers and dependents. We interviewed company owners and managers. Below are summaries of the findings:
- All of the companies care about employee health and financial well-being. They strive to provide reliable health insurance, though employees often have other options (spousal coverage or Medicaid).
- Strategies vary widely in terms of types of coverage. Most companies reported substantial management time overseeing the insurance process. Several companies have utilized brokers or consultants for assistance.
- The two largest companies (both in the manufacturing industry) incurred unique costs related to being self-insured.
- Premium and other financial costs represented 4% to 27% of labor costs. The management cost component is up to 50% of the premium cost. Employee productivity lost to insurance activities was not significant. While there hasn’t been a significant impact on business operations, such as strategies to increase production to meet demand surges, it does affect hiring and can lead to significant costs.
Below are direct quotes from some of those interviews:
“Where [health insurance] really has an impact is who we can hire. The people who would want to work for us would want insurance and so that was always a big barrier to getting talent.”—Owner, Custom Gifts and Products company
“The cost of health insurance has limited, I mean that there’s a certain limit to my profit margin and particularly with other factors such as supply chain issues... I’m getting squeezed on a lot of different fronts, and if my health insurance didn’t go up 10% every year, I could pay people 10% more every year... They don’t want to give up their health insurance, but I think they know that it’s suppressing the wages that we can pay.”—Owner, Print and Design company
“All my employees are friends of mine. It really pains me to see them not go to the doctor, especially for specialists... And our specialist cost is very high... And for some of our employees, especially the warehouse employees, they’re not super high compensation.”—Owner, Aviation Distribution company
To conclude, job-based insurance poses health-related and financial burdens on company employers and employees. These burdens would disappear with the implementation of a national single-payer healthcare system.
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Take Back America From the Oligarchs
What we are witnessing is not just economic decline—it is a calculated transfer of power, wealth, and dignity from the people who built this country to the corporate and political class who believe they own it.
Apr 12, 2025
America is not being lost. It's being taken.
Taken from the factory worker in Michigan whose job was shipped overseas. From the farmer in Indiana watching crops wither while markets close, subsidies disappear, and tariffs crush their bottom line. From the mother in Ohio who can't feed her children because her food stamps have been cut. From the young man in Kentucky forced to choose between insulin and rent. From the senior in Pennsylvania being told to drive to a Social Security office to collect their check—only to find their local office closed, and the nearest one hours away.
This isn't just mismanagement—it's betrayal.
We are not spectators. We are not statistics. We are the heart of this nation. And it's time we acted like it.
Major companies that were built by American labor—Ford, Caterpillar—are moving out. They're being driven out by a political agenda that's sent material costs soaring through reckless tariffs. To stay afloat, they chase cheaper labor overseas, leaving hollowed-out towns and broken families in their wake.
Meanwhile, politicians slash food assistance, threaten Social Security and Medicaid, and then have the audacity to tell us the economy is strong and it's in our best interest. They smile on TV while the working class suffers.
The elites in Washington tell us to be patient. To wait. That it's complicated. But we know what we see. Our communities are drying up. The jobs are gone. The wages are stagnant. Our groceries are more expensive. The promises are broken.
What we are witnessing is not just economic decline—it is a calculated transfer of power, wealth, and dignity from the people who built this country to the corporate and political class who believe they own it.
The Human Cost
Consider the typical of a lifelong resident of a small town in Ohio. A person who worked at the local manufacturing plant for over 20 years, a job that provided her family with stability and a sense of pride. When the plant closed due to outsourcing, she found herself unemployed, struggling to make ends meet. The ripple effect was felt throughout the community—local businesses shuttered, schools faced budget cuts, and the town's spirit diminished. Her story is not unique; it's a narrative echoed in countless towns across America.
The Illusion of Prosperity
Politicians tout stock market highs and corporate profits as indicators of economic health, but these metrics are detached from the reality most Americans face. While the wealthiest accumulate more, the average worker sees little improvement. The gig economy grows, offering precarious employment without benefits or security. The middle class shrinks as the dream of upward mobility becomes increasingly elusive.
A Call to Action
Enough.
We are not spectators. We are not statistics. We are the heart of this nation. And it's time we acted like it.
Rise Up.
Get off your knees. Don't just sit on the couch and watch it happen. Rise up! Use your voice. Post your grievances. Use social media. Call your representatives. Write letters. Talk to your neighbor. See what's happening. What they're doing isn't how a country should treat its people—and it damn sure isn't right.
Rise up by showing up. At the ballot box. At the school board. At the union hall. At the town meeting. Wherever decisions are made, do what you can. Your presence matters.
Rise up because this country wasn't built by the connected—it was built by the committed. By steelworkers and carpenters. Nurses and truck drivers. Teachers and veterans. People who worked with their hands, loved with their hearts, and built the greatest nation on Earth.
Reclaiming Our Future
It's time to take it back.
Take back our jobs. Demand fair trade policies that protect American workers and hold corporations accountable for outsourcing. Support local businesses and invest in community initiatives that foster economic resilience.
Take back our towns. Advocate for infrastructure projects that create jobs and improve our communities. Push for affordable housing and quality education that ensure a brighter future for the next generation.
Take back our dignity. Stand up against policies that favor the wealthy at the expense of the working class. Demand transparency and integrity from our leaders.
Take back our rights. Protect the social safety nets that safeguard our most vulnerable. Fight for healthcare, fair wages, and the right to organize.
And take back America.
We are many. Let them hear us. Let them know—we will not be silent.
To the politicians in power—the ones slashing our benefits, outsourcing our jobs, gutting our economy—then turning around and telling us it's for our own good... I've got one thing to say to you:
Don't piss on my leg and tell me it's rain.
Take Back America.
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