Work Requirements for Medicaid are Back on the Negotiating Table. They are Still a Terrible Idea.
By Suzanne Wikle
Congressional Republicans and Arkansas administrators have both recently revived the idea of so-called work requirements for Medicaid. The two proposals are contradictory in their approach, yet both are wrong. President Biden has rightfully pledged to not take away people’s health care or increase poverty as part of the debt ceiling negotiations. The administration must hold this line and reject any new work requirements for Medicaid, or increased work requirements for the Supplemental Nutrition Assistance Program (SNAP) and Temporary Assistance for Needy Families (TANF).
We’ve known for decades that work requirements in SNAP and TANF primarily serve to limit people’s access to programs. They don’t equip people with tools or employment that allow them to leave poverty. In 2018, not surprisingly, we learned that work requirements in Medicaid produce the same results.
In 2018 Arkansas became the first state to implement work requirements in Medicaid, under a waiver approved by the Trump Administration. As a result, 18,000 people lost Medicaid coverage and there was no significant increase in employment. Federal courts eventually blocked this waiver as inconsistent with the intent of the Medicaid program.
Un-deterred by the data, Republicans in the U.S. House of Representatives are doubling down on this bad idea in the debt ceiling debate. They’re putting forward a proposal that would force all states to impose work requirements — requiring people to navigate a paperwork maze to prove they are in compliance of working enough or exempt from the requirement, and losing coverage if they don’t.
The approach reiterates the false and paternalistic narrative that people experiencing poverty do not want to work, so they must be forced or incentivized to do so. It’s part of the deeply racist history of work requirements.
Speaker McCarthy’s caucus is pursuing the same onerous and punitive type of work requirements that ultimately do nothing to help people get ahead in life while simultaneously cutting people off essential safety-net programs. Proposals to implement or “strengthen” work requirements are veiled attempts to cut programs and limit people’s access to health care, nutrition support, and limited cash assistance.
Ironically, Arkansas now acknowledges that their previous approach of onerous and punitive reporting requirements was not productive. In their latest proposal, the state says, “While the intent (of the work requirement) was to encourage beneficiaries to engage in their communities and the workforce to achieve economic growth and eventual independence from government dependency, the monthly reporting of engagement hours was burdensome”.
Arkansas is now proposing to provide many people enrolled in Medicaid with “success coaches” to help them address Health Related Social Needs (HRSN) and increase their income above the Medicaid eligibility threshold. Helping people with a resume won’t ensure they have access to affordable child care, affordable housing, and a living wage that allows them to meet their needs.
A more productive approach would be to eliminate red tape and ensure that every Arkansan eligible for Medicaid can enroll—and stay enrolled. We know that Medicaid enrollment supports employment and decreases family financial stress. The U.S. Centers for Medicare and Medicaid Services (CMS) should reject the work-related components of Arkansas’ latest waiver.
Given all the evidence that work requirements don’t work, it’s reasonable to wonder why they are consistently raised, usually by leaders who ideologically oppose safety-net programs. One reason is that they know voters will reject straightforward proposals to cut or eliminate Medicaid. Recent election cycles have shown that voters don’t think politicians should take away peoples’ health care and state ballot initiatives have highlighted Medicaid’s popularity.
President Biden is right to draw a line in the debt ceiling debate, opposing any domestic spending cuts that will lead to people losing their health care or more living in poverty.
The House-passed debt ceiling bill now threatens all three programs with new or increased work requirements. Senate Democrats must help the White House hold this line. Further legitimizing work requirements as a reasonable policy is a slippery slope for continued attacks and cuts on programs.