The House Republicans’ debt ceiling bill includes drastic cuts to federal programs that seniors and other vulnerable Americans rely on. But it also imposes work requirements on lower income people who receive health coverage through Medicaid. Under the GOP plan, Medicaid patients would have to work at least 80 hours per month or lose their coverage.  We spoke to the National Committee’s senior health policy expert, Anne Montgomery, about why this is such a bad idea. 

Q:  Why is imposing work requirements on Medicaid patients such a harmful idea?

A:  It’s harmful because regardless of whether or not you’re working, everyone needs ongoing access to health care. Medicaid is a health insurance program for lower-income Americans, not a work program. It makes no sense to deny medical coverage to people by requiring them to prove to state bureaucrats that they are working. If you need care, you should be able to get it. To condition one upon the other makes no sense.

Q: Why shouldn’t Medicaid beneficiaries have to work in order to keep their benefits? 

A:  There are many people who may not be able to work due to chronic health conditions or disabilities. Or they may be taking care of loved ones who are sick. There are others who, because of the ‘gig economy,’ may be in and out of work and have trouble finding steady employment. Turnover is particularly high (and work hours inconsistent) in the service and retail sectors. Under the Republican proposal, if you don’t have consistent work, you may lose your health coverage.

Q:  Couldn’t some of these workers simply apply for disability insurance?

A: It’s not as simple as snapping your fingers, and you’re on disability.  First of all, only 40% of people who apply for Social Security Disability Insurance (SSDI) actually are approved for benefits. Secondly, why would you want people to go onto disability insurance if the aim is to encourage work?

Q: With these work requirements comes a lot of new ‘red tape.’ How might this be an obstacle to people trying to keep their Medicaid coverage?

A: Yes. Not only would you have to be working – or find work – in order to keep your health coverage, you would have to meet strict documentation requirements, which involves additional red tape and paperwork. In pilot programs for Medicaid work requirements, people have lost coverage because of confusion rather than not working. Medicaid beneficiaries should work when they can, but we shouldn’t yank their health care from under them if they can’t work at a particular time.

Q: Would Medicaid work requirements seriously increase the number of Americans working?

There is no evidence that Medicaid work requirements actually would boost employment. In states which have experimented with work requirements, that certainly isn’t the case. In Arkansas, for instance, 17,000 patients lost Medicaid coverage for failing to meet the requirements. An analysis found that “Medicaid beneficiaries had not started working more or earning more money as a result of the policy.”

Q: What is the real agenda behind Medicaid work requirements?

Conservatives have long opposed Medicaid as “just another welfare program” and a “waste of taxpayer dollars,” while in reality it is a crucial part of our health care system that pays for coverage for tens of millions of lower-income Americans — and the hospitals, doctors and nursing homes who care for them. In fact, according to the Centers for Medicare and Medicaid (CMS), more than 92 million Americans were enrolled in Medicaid and CHIP (in the 50 states and the District of Columbia that reported enrollment data for December 2022).   The GOP was especially upset by Medicaid expansion under the Affordable Care Act (though many red states now have expanded their Medicaid programs under the ACA). Imposing work requirements is a way to drastically reduce the number of Americans on Medicaid rolls, with no regard for the impact on patients’ health.

Q: The Republicans’ work requirement proposals come at a particularly fraught time, as federal COVID emergency measures come to an end, right? 

A: That’s right. Under the Public Health Emergency (PHE) state Medicaid programs were required to keep people continuously enrolled in exchange for additional federal funding. With the PHE phaseout that begin this month, millions of Americans will now have to go through a “redetermination” of their eligibility for Medicaid coverage for the first time in 3 years.  Imposing work requirements at the same time that many are already losing access to Medicaid coverage is punitive and unnecessary. Republicans are effectively using this process as an opening to slash federal spending on a constituency that they believe doesn’t have a lot of political power.