Speaker McCarthy released his long-awaited proposal to address the debt ceiling. As expected, he included a provision to impose work requirements in Medicaid. For the National Health Law Program, Medicaid is our bread-and-butter. We were founded over 50 years ago to protect and expand on Medicaid and we still do that today. Speaker McCarthy’s proposal to add work requirements to Medicaid has been a Republican goal for decades despite significant evidence that work requirements don’t work! It’s a wolf in sheep’s clothing – it may sound like a good idea in theory but it masks the reality of a morass of paperwork and documentation requirements, added costs for states to administer, and the loss of coverage for way too many Medicaid enrollees.
Speaker McCarthy’s proposal to add work requirements to Medicaid has been a Republican goal for decades despite significant evidence that work requirements don’t work!
By design, work requirements push people out of health care due to burdensome reporting requirements as most Medicaid enrollees are already working. Their jobs just don’t offer health insurance or affordable insurance.
How do we know they don’t work? All we have to do is look to Arkansas, the only state that actually has implemented work requirements in Medicaid to date. In the first month that Arkansas’ penalties kicked in, the work requirements ended Medicaid coverage for 4,300 people. A total of more than 18,000 of Arkansas’ Medicaid enrollees lost their health coverage because they did not report sufficient hours of work or work-related activities last year. It also led to worse health and economic outcomes for those affected. People reported delaying care, rationing medication, and incurring increased medical debt.
The story of Adrian McGonigal illustrates the destructive nature of the work requirements, even among people who are working. As highlighted in PBS NewsHour, Mr. McGonigal had a full-time job and knew he was required to report his hours. But because the notice the state sent was difficult to understand, he believed that he only needed to verify his work hours once, instead of every month as required. He first realized the state had taken away his health coverage when he tried to fill a prescription and was turned away. No longer able to afford medicine, he became so sick that he was hospitalized and missed so much work that he lost his job – all because of the work requirements.
Want more examples of people who would lose their coverage if work requirements were implemented? We filed lawsuits (and won!) against other Trump approvals of work requirements in Medicaid. Here are some of the stories of the Medicaid enrollees subject to work requirements in those cases: New Hampshire, Indiana, Kentucky, and others in Arkansas. We could also look to the outsized detrimental impact work requirements would have on people with disabilities, women and LGTBTQI+ individuals, and on health equity. While we wrote many of these documents in 2018, the same problems have not gone away and will not under McCarthy’s proposal – they will only get worse.
We could give you other reasons why work requirements are a bad idea for Medicaid. Work requirements are legally suspect under current Medicaid law and don’t further the objectives of the Medicaid program. They’re not a healthy choice as they create barriers to coverage and the pathway to health that Medicaid represents. Republicans say they’ll save money but that only happens when people lose coverage because the documentation requirements cost states more to develop and track.
Work requirements don’t make people healthier and don’t lead to long-term employment. As seen in Arkansas, rather than promoting work, these requirements add red tape and become barriers to employment causing thousands to lose coverage. That number could be millions if implemented nationwide.
Work requirements don’t make people healthier and don’t lead to long-term employment.
It would truly be a terrible, horrible, no good very bad result if Congress repeated Arkansas’ experience across the country. We can’t let that happen!