House Republicans have proposed adding work requirements to Medicaid, the health insurance program serving tens of millions of low-income Americans. Their plan, unveiled Sunday, would, with a few exceptions, strip coverage from childless adults who cannot document at least 80 hours of monthly employment.
Many Americans are intrigued by the idea of conditioning benefits on work. A recent poll from KFF, a nonpartisan health research group, found that over 60 percent of American adults supported such requirements, probably influenced by persistent myths about widespread unemployment among public assistance recipients.
Yet despite its potential political popularity, imposing work requirements on Medicaid is a fundamentally misguided policy. In the debate over work requirements, it is easy to get sucked into abstract moral theorizing about what a society owes people who can work but refuse to do so. This sort of philosophizing is interesting, but it tends to elide the fact that it is employers, not workers, who make hiring, firing and scheduling decisions.
Last year, over 20 million workers were laid off or fired at some point from their jobs. Many of those workers ended up losing not just all of their income but also their employer-sponsored health care. Medicaid is supposed to provide a backstop for these workers, but if we tie eligibility to work, they will find themselves locked out of the health care system because of decisions their employers made, often for reasons beyond their control.
Even workers who are able to get and keep jobs do not decide how many hours they are scheduled for. Many low-wage employers assign shifts based on real-time estimates of consumer demand, resulting in unpredictable work hours for their employees. Through no fault of their own, these workers frequently see their schedules drop below 80 hours a month. The resulting income instability creates significant hardships for them. Eliminating their health insurance would only make things worse.
The inherent unfairness of penalizing people for things they cannot control might be tolerable if it manages to result in a large employment increase. But it doesn’t. Arkansas tried Medicaid work requirements seven years ago. The state used the requirements to remove 18,000 adults from the Medicaid rolls in just four months. Yet subsequent studies found that it had no positive employment effect. This is one of the reasons even many conservative policy thinkers who generally support work requirements balk at using them for Medicaid.
