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matt bruenig
Policy Expert Details Cruelty and Pointlessness of GOP's Medicaid Work Requirements
"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," wrote Matt Bruenig of the People's Policy Project.
May 16, 2025
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 Postreported Friday that in Georgia, "just12,000 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.
"Somewho 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.
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Huge Administrative Waste Makes Clear For-Profit Insurance Is 'Actually Very Bad': Analysis
"It is totally fair for people to identify private insurers as the key bad actor in our current system," writes Matt Bruenig of the People's Policy Project. "The quicker we nationalize health insurance, the better."
Dec 10, 2024
Last week's murder of UnitedHealthcare CEO Brian Thompson brought to the surface a seething hatred of the nation's for-profit insurance system—anger rooted in the industry's profiteering, high costs, and mass care denials.
But that response has led some pundits to defend private insurance companies and claim that, in fact, healthcare providers such as hospitals and doctors are the real drivers of outlandish U.S. healthcare costs.
In an analysis published Tuesday, Matt Bruenig of the People's Policy Project argued that defenders of private insurers are relying on "factual misunderstandings and very questionable analysis" and that it is reasonable to conclude that the for-profit insurance system is "actually very bad."
"From a design perspective, the main problem with our private health insurance system is that it is extremely wasteful," Bruenig wrote, estimating based on existing research that excess administrative expenses amount to $528 billion per year—or 1.8% of U.S. gross domestic product.
"All healthcare systems require administration, which costs money, but a private multi-payer system requires massively more than other approaches, especially the single-payer system favored by the American left," Bruenig observed, emphasizing that excess administrative expenses of both the insurance companies and healthcare providers stem from "the multi-payer private health insurance system that we have."
He continued:
To get your head around why this is, think for a second about what happens to every $100 you give to a private insurance company. According to the most exhaustive study on this question in the U.S.—the CBO single-payer study from 2020—the first thing that happens is that $16 of those dollars are taken by the insurance company. From there, the insurer gives the remaining $84 to a hospital to reimburse them for services. That hospital then takesanother $15.96 (19% of its revenue) for administration, meaning that only $68.04 of the original $100 actually goes to providing care.
In a single-payer system, the path of that $100 looks a lot different. Rather than take $16 for insurance administration, the public insurer would only take $1.60. And rather than take $15.96 of the remaining money for hospital administration, the hospital would only take $11.80 (12% of its revenue), meaning that $86.60 of the original $100 actually goes to providing care.
High provider payments, which some analysts have suggested are the key culprit in exorbitant healthcare costs, are also attributable to the nation's for-profit insurance system, Bruenig argued.
"Medicaid and Medicare are able to negotiate much lower rates than private insurance, just as the public health insurer under a single-payer system would be able to. It is only within the private insurance segment of the system that providers have been able to jack up rates to such an extreme extent," he wrote. "Given all of this, I think it is totally fair for people to identify private insurers as the key bad actor in our current system. They are directly responsible for over half a trillion dollars of administrative waste and (at the very least) indirectly responsible for the provider rents that are bleeding Americans dry."
"The quicker we nationalize health insurance," he concluded, "the better."
Bruenig's analysis comports with research showing that a single-payer system such as the Medicare for All program proposed by Sen. Bernie Sanders (I-Vt.), Rep. Pramila Jayapal (D-Wash.), and other progressives in Congress could produce massive savings by eliminating bureaucratic costs associated with the private insurance system.
One study published in the Annals of Internal Medicine in January 2020 estimated that Medicare for All could save the U.S. more than $600 billion per year in healthcare-related administrative costs.
"The average American is paying more than $2,000 a year for useless bureaucracy," said Dr. David Himmelstein, lead author of the study, said at the time. "That money could be spent for care if we had a Medicare for All program."
Deep-seated anger at the systemic and harmful flaws of the for-profit U.S. insurance system could help explain why the percentage of the public that believes it's the federal government's responsibility to ensure all Americans have healthcare coverage is at its highest level in more than a decade, according to Gallup polling released Monday.
"There's a day of reckoning that is happening right now," former insurance industry executive Wendell Potter, president of the Center for Health and Democracy, said in an MSNBCappearance on Monday. "Whether we're talking about employers, patients, doctors—just about everybody despises health insurance companies in ways that I've never seen before."
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Biden's Hands 'Will Be Bloody' If He Lets Trump Inherit Death Row Cases, Critics Warn
"President Biden came into office committing to abolishing the federal death penalty because of its fundamental flaws. Commuting the federal row is the way he can honor that commitment," said one advocate.
Dec 03, 2024
For weeks, President Joe Biden has faced calls to use his clemency powers to save the lives of federal inmates on death row ahead of a transfer of power to President-elect Donald Trump, who has said he will expand the use of the death penalty.
Biden's inaction on the issue has drawn increased scrutiny following his pardon of his own son, Hunter Biden, clearing the younger Biden of wrongdoing in any federal crimes he committed or may have committed in the last 11 years.
Presidents have broad authority under Article II, Section 2 of the Constitution to grant pardons and reprieves for federal crimes. Biden recently pardoned two Thanksgiving turkeys as part of an annual tradition to highlight these constitutional powers, but he has not issued commutations for the 40 incarcerated men on federal death row. (He did, however, order a moratorium on carrying out federal death sentences in 2021).
"If Biden does not act, there is little doubt that Trump will aggressively schedule executions in his next term. Their blood will primarily be on Trump's hands, but, if Biden does not act to prevent it, his hands will be bloody too," wrote Matt Bruenig, president of the People's Policy Project think tank, reacting to the news of Hunter Biden's pardon.
"The death penalty is a morally-bankrupt and inescapably racist institution" —Yasmin Cader, ACLU deputy legal director
The pardoning of Hunter Biden, who was awaiting sentencing in two federal cases, also prompted scrutiny around pardon actions Biden could take that are not just focused on death row.
"This," wrote Rep. Rashida Tlaib (D-Mich.) in response to a post on X that contrasted Hunter Biden's pardon with the fact that tens of thousands of people are in federal custody for drug offenses.
In 2020, Biden pledged to work to abolish the federal death penalty but, according to the Death Penalty Information Center, "there has been little evidence of anything done in furtherance of this promise."
Pressure to issue clemency was building prior to the announcement of Hunter Biden's pardon.
On November 20, over 60 members of Congress sent a letter to Biden, encouraging him to use his "clemency powers to help broad classes of people and cases, including the elderly and chronically ill, those on death row, people with unjustified sentencing disparities, and women who were punished for defending themselves against their abusers."
During a press conference in November that featured House Democrats and anti-death penalty advocates, Rep. Ayanna Pressley (D-Mass.) said that "those on death row who are at risk of barbaric and inhumane murder at the hands of the Trump administration can have their death sentence commuted and be resentenced to a prison term," according to Oklahoma Voice.
"We're here today to ask him to take another step in that direction and to demonstrate, once again, a very positive consequence of his having been elected our 46th president, and to carry out his clemency powers in a very positive way," Rep. James Clyburn (D-S.C.) said.
Meanwhile, the ACLU has also urged Biden to use the lame duck session to commute federal death sentences—pointing out that Trump has vowed to expand the death penalty, including to non-homicide crimes such as drug-related offenses.
"The death penalty is a morally-bankrupt and inescapably racist institution. President Biden came into office committing to abolishing the federal death penalty because of its fundamental flaws. Commuting the federal row is the way he can honor that commitment, and prevent irreversible miscarriages of justice," said Yasmin Cader, ACLU deputy legal director and the director of the Trone Center for Justice and Equality.
While Biden so far has granted far fewer pardon and commutation petitions compared to former President Barack Obama, according to the Department of Justice's Office of the Pardon Attorney, he did in 2022 grant full and unconditional pardons to all U.S. citizens convicted of simple federal marijuana possession—a move that was cheered by advocates.
"President Joe Biden can—and must—act now to finish the death penalty reform work his administration began in 2020," the ACLU said last month. "He must commute the sentences of all people on federal death row to stymie Trump’s plans and to redress the racial injustice inherent to capital punishment."
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