Medicaid Work Requirements Would Leave More Lowincome People Without Health Insurance But This Policy Is Unlikely To Pass This Time Around

The package of legislation passed by the US House of Representatives on April 26, 2023 is unlikely to exceed federal spending over the next decade, and also raise the national debt ceiling. A key measure in the Republican-backed bill would limit access to Medicaid for millions of Americans.

Approximately one in four Americans has health insurance under this program, which primarily serves low-income and disabled individuals and is jointly funded by the federal and state governments. If the Republican-backed law goes into effect, the federal government will require Medicaid-insured adults ages 19 to 55 who don't have children or other dependents to do 80 hours a month of paid work, training, or community service.

Medical scientist Simon F. Hyder asked for a call to explain what the proposed job requirements would be and why the Republican effort is important to the millions of Americans who depend on Medicaid.

What will change when this policy is implemented?

Unlike other government programs that help low-income Americans, including the Supplemental Food Assistance Program, or SNAP, and Temporary Assistance for Needy Families, Medicaid currently has no work requirements.

The package recently approved by the House of Representatives will force all states to implement this policy. An estimated 15 million Americans with Medicaid should be eligible.

This change will greatly increase the administrative burden for Medicaid recipients of mixed incomes, people with disabilities, and non-whites. KFF, a non-profit health research firm, estimates that 1.7 million people will lose public insurance. However, countries have the option to continue paying these people using only public funds.

Not only those who are subject to the new rules will be at risk. Many liberated peoples, including the elderly and the disabled, are known to have difficulty with paperwork or do not understand complex bureaucratic rules. Many experts suggest that the loss of coverage could be even greater in this demographic as states view them as people who do not qualify for the job.

Are there precedents for this policy?

This isn't the first time Republicans have tried to condition access to Medicaid to employment requirements, at least for some beneficiaries. The Trump administration has worked with several Republican-led states to use the so-called 1115 protest waiver for this purpose. These exemptions allow states to make temporary changes to their Medicaid programs that deviate from certain legal requirements. However, these efforts were quickly blocked in court. Most of them never flew before the Biden administration withdrew them.

The exception is Arkansas.

Arkansas began introducing adult work requirements between the ages of 30 and 49 for Medicaid recipients in June 2018. As a result, approximately 1 in 4 Arkansas covered by the policy lost their insurance at the end of the year, and the courts declared it illegal.

The Arkansas experience, especially balanced for recipients, echoes many of the fears of job-demand opponents. It is important to note that many lost coverage not because they did not complete the required hours of paid work, training, or community service, but because they struggled to cope with bureaucratic problems.

Efforts are also under way in Georgia to establish work requirements for Medicaid beneficiaries, despite legal hurdles and objections from the Biden administration. With President Joe Biden in office, it will be difficult to test this policy unless Congress passes something like a House of Representatives package.

Will it be different this time?

The states had to actively pursue the waivers that the Republicans accepted when former President Donald Trump was in the White House. This meant Medicaid recipients in Democratic-ruled states like California were less likely to run into them.

The proposed changes to the House bill would force all states to introduce work requirements for adults aged 18 to 55 with no dependents. Failure to do so would put states at risk of losing federal funds, so democratically governed states would also have to adopt these rules. The proposed changes will also avoid many of the legal issues that previously prevented widespread adoption of Medicaid's job requirements.

It is important to note that this policy change would coincide with continued instability for Medicaid beneficiaries. This is because millions of Medicaid recipients are already covered due to the COVID-19 public health emergency declaration expiring on May 11 and April 1, when states will resume determining if Medicaid recipients become ineligible. As long as the state policy of continuous enrollment was in place, the states could not disqualify anyone from Medicaid.

As of January 2023, the number of people covered by this program has increased to 93 million people.

Is this policy consistent with the goals of Medicaid?

Medicaid's goal has always been to give low-income people access to comprehensive health insurance for as long as they need to. However, Medicaid is strictly a health insurance program.

Some other social protection programs aim to achieve more than one goal. For example, the official mission of Temporary Assistance to Needy Families is to "end needy parents' dependence on government subsidies by promoting career, employment, and marriage readiness," not just help needy parents make ends meet.

At the same time, there is evidence that Medicaid promotes greater labor force participation by providing affordable health insurance and access to essential health care. If you are sick, it can be much easier to get the treatment you need for your condition so that you can continue to work. In fact, most working adults work for Medicaid.

Ironically, pushing people out of Medicaid because they don't qualify for the job or because they find it hard to navigate the bureaucracy risks cutting the number of people working.

Why is it important?

It seems unlikely that Medicaid job requirements will become law in 2023 or 2024, given strong opposition to their implementation from Democrats and the majority party in the Senate. However, given the potentially dramatic consequences of defaulting on the national debt, some Democrats may be willing to relent.

For now, I think Republicans in Congress are setting the stage for future efforts to create more welfare programs to meet job needs, especially when a Republican becomes President of the United States.

If measures like those passed by the House of Representatives as part of the Republican debt ceiling package become law, even Democratic-led states may have nothing to resist.

This article is a new publication from The Conversation, an independent non-profit news site dedicated to the exchange of views among academic experts. The Conversation is trusted expert news from an independent non-profit organization. Try our free newsletter.

Written by Simon F. Hyder, Texas A&M University .

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Simon F. Hyder receives financial support from the Robert Wood Johnson Foundation and the Commonwealth of Pennsylvania.

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