Republicans' Proposed Medicaid 'Work Requirements' Would Affect 10 Million

Adults without dependents or disabilities would lose health coverage if they couldn't document time spent working.
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WASHINGTON ― More than 10 million Medicaid enrollees would be subject to “work requirements” under Republicans’ new proposal to cut federal spending in exchange for letting the government pay its bills.

Some of those Medicaid recipients would be able to meet the requirements and retain their health care coverage, but others would lose it, according to a new analysis from the Center on Budget and Policy Priorities, a liberal think tank.

Part of the problem is that even if they work enough hours to fulfill the requirement, some on Medicaid might struggle to document their work history with the government.

“A large share of the 10 million people subject to the requirements would have to navigate complex work-reporting and verification systems each month while others would have to navigate the exemption process periodically to retain coverage,” the center’s Gideon Lukens reported Friday.

The work requirements were included in a broader bill released Wednesday by House Speaker Kevin McCarthy (R-Calif.) as part of a standoff with President Joe Biden over federal spending and the national debt.

Sometime this summer, the federal government could fail to pay its bills unless Congress increases a legal limit on the amount of money the U.S. Treasury Department can borrow. The government needs to sell debt to cover expenses that exceed incoming tax revenue.

Republicans, led by McCarthy, say the $31 trillion national debt is already too high and that Democrats should agree to spending cuts in order to slow the debt’s growth. To that end, their bill calls for across-the-board cuts to federal agencies, plus new limits on benefits for unemployed Americans receiving federal health and nutrition benefits.

The legislation is symbolic, since Democrats control the Senate and the White House, but its House passage would likely strengthen McCarthy’s hand in future negotiations with Biden.

“A large share of the 10 million people subject to the requirements would have to navigate complex work-reporting and verification systems each month while others would have to navigate the exemption process periodically to retain coverage.”

- Gideon Lukens, Center on Budget and Policy Priorities

The bipartisan Committee for a Responsible Federal Budget estimated that the proposed work rules would save the government about $100 billion over a decade, representing only around 2% of the bill’s overall estimated $4.5 trillion in savings.

Despite their relatively small effect on the federal budget, Republicans have highlighted the work requirements, suggesting that cutting support to able-bodied adults would nudge them into the workforce and make it easier for businesses to hire.

“Our plan ensures adults without dependents earn a paycheck and learn new skills,” McCarthy said this week.

The Congressional Budget Office has said that work requirements in Medicaid and the Supplemental Nutrition Assistance Program have reduced benefits more than they’ve increased earnings.

Childless Medicaid recipients ages 18 to 55 would have to work 20 hours per week under the McCarthy proposal or spend an equivalent amount of time volunteering or in a training program. States would be required to try to verify Medicaid recipients’ work, such as by checking payroll data, before asking individuals to verify.

One obstacle to passing the bill is that far-right lawmakers have said the work proposal isn’t strict enough. Rep. Matt Gaetz (R-Fla.), for instance, told reporters on Thursday that the requirement should be 30 hours a week rather than 20. But a stricter proposal would likely alienate more moderate Republicans. McCarthy has a slim margin and can lose the support of only four Republicans and still pass the bill.

Medicaid covers health care costs for 85 million low-income Americans, most of them parents and children, and for most of its history has not had a work requirement. The Donald Trump administration let states try work rules, and in 2018 about a quarter of Arkansas Medicaid recipients subject to the rule lost coverage.

Partly by extrapolating from what happened in Arkansas, the CBO estimated that a national Medicaid work requirement would cut enrollment by 2.2 million annually.

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