Medicaid work requirements would leave more low-income people without health insurance – but this policy is unlikely to pass this time around

The legislative package the U.S. House of Representatives passed on April 26, 2023, by a narrow margin would pare federal spending over the next decade while also raising the debt ceiling. One important measure in the Republican-backed bill would restrict access to Medicaid for millions of Americans.

About 1 in 4 Americans have health coverage through the program, which primarily serves low-income and disabled people and which is funded jointly by the federal government and the states. Should the Republican-backed legislation prevail, the federal government would require adults insured by Medicaid who are 19 to 55 years old and don’t have children or other dependents to spend 80 hours a month doing paid work, job training or community service.

The Conversation asked Simon F. Haeder, a public health scholar, to explain what the proposed work requirements would do and why the Republican effort to institute them matters for the millions of Americans who rely on Medicaid.

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

The package the House recently passed would require all states to implement this policy. An estimated 15 million Americans with Medicaid would need to comply with the requirements.

This change would dramatically increase bureaucratic hassles for Medicaid beneficiaries who are disproportionately low-income, disabled and nonwhite. KFF, a health care research nonprofit, estimates that 1.7 million people would lose federal coverage. However, states have the option to continue to pay for these individuals solely with state funds.

Those who would be subject to the new rules would not be the only ones at risk. It is well known that many of the exempt populations, including the aged and disabled, struggle to complete paperwork or fail to understand complex bureaucratic rules. Many experts predict that coverage losses could be even higher among these demographics, as states would consider them to be out of compliance with work requirements.

This is not the first time that Republicans sought to make access to Medicaid contingent on meeting work requirements for at least some beneficiaries. The Trump administration worked with various Republican-led states to use what are known as 1115 demonstration waivers for that purpose. These waivers allow states to make temporary changes to their Medicaid programs that depart from certain statutory requirements. However, those efforts were quickly blocked in court. Most were never even piloted before the Biden administration rescinded them.

One exception is Arkansas.

Arkansas began imposing work requirements on Medicaid recipients on adults ages 30 to 49 starting in June 2018. As a result, about 1 in 4 Arkansans subject to that policy ended up losing their coverage by the end of that year before courts deemed it unlawful.

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