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work requirements
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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'What Don't They Want You to Know?' GOP Sets 1 AM Hearing to Advance Disastrous Medicaid Cuts
"They have such contempt for the American people," said Democratic Rep. Jim McGovern.
May 20, 2025
House Republicans are set to take the next step toward passage of their sprawling reconciliation bill at a Wednesday hearing scheduled to begin while most Americans are fast asleep.
The GOP-controlled House Rules Committee will convene at 1 am ET Wednesday morning to consider the legislation and recent changes pushed by Republican hardliners, who are demanding even more aggressive cuts to Medicaid and green energy programs.
Specifically, a faction of far-right Republicans led by Rep. Chip Roy of Texas wants the bill's proposed work requirements for Medicaid recipients to take effect earlier than the originally proposed 2029 start date. House Majority Leader Steve Scalise (R-La.) said Tuesday that Republicans had settled on "early 2027" as a new start date.
While the House Rules Committee has not responded to reporters' questions about the timing of Wednesday's hearing, critics said it appears to be an attempt to avoid the kinds of protests and public scrutiny that daytime meetings have attracted.
Rep. Jim McGovern (D-Mass.), the ranking member of the rules panel, blasted his Republican colleagues over the dead-of-night hearing time, writing on social media that "they have such contempt for the American people."
"If Donald Trump's big beautiful tax break for billionaires is so great... why not pass it in primetime?" McGovern asked. "Why jam it through in the middle of the night? What don't they want you to know?"
Rep. Debbie Dingell (D-Mich.) added that "if you think you are doing what is right for the American people, you don't consider it in the dead of night."
"This bill doesn't just cut Medicaid, it guts Medicaid, and it will cause millions of eligible people in House districts across the country to lose access to the Medicaid benefits they need."
The GOP reconciliation package, a centerpiece of President Donald Trump's legislative agenda, would slash Medicaid and federal nutrition assistance by more than a trillion dollars combined over the next decade—cuts that would help offset the cost of massive tax breaks for rich Americans.
The spending cuts, which would be achieved in part through draconian and ineffective work requirements, would strip healthcare coverage and food aid from millions of Americans and potentially devastate rural hospitals, farmers, and local economies.
"Instead of listening to the millions of Americans clogging their phone lines and showing up at townhalls, or even those in their own party warning against severe cuts to Medicaid, House Republicans are making bigger cuts and terminating people's healthcare coverage even faster," said Anthony Wright, executive director of Families USA.
"This bill doesn't just cut Medicaid, it guts Medicaid, and it will cause millions of eligible people in House districts across the country to lose access to the Medicaid benefits they need," Wright said. "When will we hear from those members?"
Later Wednesday morning, Medicaid recipients from across the country—including districts represented by House Republicans—are set to gather on Capitol Hill to protest the GOP legislation.
"Upon arrival on May 21, they will hold a press conference, demand face-to-face meetings, deliver petitions signed by thousands of constituents urging GOP decisionmakers to change course, and take direct action in order to be heard," the People's Action Institute and Popular Democracy said Tuesday.
"The plan to eviscerate Medicaid and other programs in order to siphon public dollars into the pockets of billionaires who already pay less in taxes than working families is universally unpopular," they added.
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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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