BEYOND THE NUMBERS
With congressional Republicans considering proposals to radically restructure Medicaid, some Republican governors are proposing their own sweeping changes to the program, including imposing work requirements on beneficiaries. But as we’ve written, a work requirement in Medicaid would penalize those least able to get and hold a job — while keeping others from improving their health and participating in the workforce.
Many adults on Medicaid are disabled or are caring for a family member. Many others have low-wage jobs that don’t offer health coverage. For those who can work, Medicaid can help them keep their job or search for work. Three-quarters of beneficiaries in Ohio who received care under the Affordable Care Act’s (ACA) Medicaid expansion and who were looking for work reported that Medicaid made it easier to do so. For those who were currently working, more than half said that Medicaid made it easier to keep their jobs.
A work requirement would likely reduce the number of people who could access care through Medicaid and there’s no evidence that it would increase employment among poor families.
The experience of the Temporary Assistance for Needy Families (TANF) program is telling. The 1996 welfare reform law converted the Aid to Families with Dependent Children program into the TANF block grant and imposed a work requirement. While touted as a “work opportunity” program, TANF has failed to increase long-term employment among its beneficiaries. Before the 1996 law took effect, 68 every 100 poor families with children received basic cash assistance to help make ends meet; today, just 23 do. Sanctions on parents who didn’t meet a work requirement have been a factor in that drop.
Furthermore, proponents of a work requirement in Medicaid often fail to propose sufficient resources for job training or other employment services, subsidized jobs, child care assistance, or other work supports to help beneficiaries prepare for work or raise their earnings. State Medicaid agencies, whose resources would be stretched even to cover the basic costs of administering and enforcing work requirements, wouldn’t likely be able to provide needed work supports within existing resources.
Moreover, most people on Medicaid who can work do so, and for people who face major obstacles to employment, work requirements won’t help to overcome them. A recent New York Times article on the work requirement proposals quotes Jimmy Brunson, a 44-year-old with diabetes and painful neuropathy in his feet who has health coverage through the ACA’s Medicaid expansion. “Even though sometimes I can get a job, you’ve got to understand, sometimes I can’t even walk,” he told the Times. If he had to work in order to keep his coverage, he says he would “probably be out.”