MÁS ALLÁ DE LOS NÚMEROS
Taking Away People’s Health Coverage and Food Assistance Will Increase Hardship, Not Employment
One of the many destructive proposals congressional Republicans are considering in their budget process is taking health coverage and food assistance away from people who don’t meet rigid work requirements. Far from the “low-hanging fruit” its proponents describe, imposing strict Medicaid work requirements and expanding already harsh requirements in SNAP will rob many millions of people of vital assistance, like other cuts being proposed. That’s a terrible price to pay to help offset the cost of tax cuts for the wealthy.
Imposing or expanding harsh work requirements will not increase employment — especially since the vast majority of assisted people who can work already do work, as I’ll show below. But it will make health care and food more costly for millions, pushing up poverty and putting health care out of reach for many. Medicaid is a vital source of health coverage for 72 million people in low-income households, and the Supplemental Nutrition Assistance Program (SNAP) helps more than 40 million low-income people afford a nutritionally adequate diet.
When policymakers take away health coverage and food assistance the impacts are serious — think of a person who loses health coverage through Medicaid and can’t get cancer treatment, an older and frail adult who loses the home-based care they need to stay out of an institution, a young adult who can’t get insulin to control their diabetes, a parent who skips meals so their children can eat, or an older worker who lost their job and has no way to buy groceries.
Based on various proposals, 36 million people or more are at risk of having their Medicaid coverage taken away under strict work requirements for working-age adults. Food assistance through SNAP would be at risk for millions under potential expansions of that program’s already strict requirement, including for over 4 million children if it is expanded to include families with school-age children. The damage would be long lasting, since food insecurity harms kids’ health, development, and performance in school, studies have shown.
Now to those facts on employment: the vast majority of people who can work do work when receiving health coverage from Medicaid or food assistance from SNAP. Nearly 2 in 3 non-elderly adult Medicaid enrollees currently do paid work, and most of the rest have a disability, are caring for family members, or are attending school (see chart). Similarly, 86 percent of SNAP households with working-age adults who are not receiving disability benefits report earnings during the year.
The evidence is clear: adults who are working, those who should be exempt due to a disability or other reason, and those who are unemployed (usually temporarily), would all be at risk of losing health coverage and food assistance under work requirement proposals.
Inflexible work requirements don’t reflect the realities of workers’ lives and jobs. Low-paid work is often unpredictable and people can struggle to log enough hours to consistently meet required minimums. Many workers in low-paid jobs have periods when they are out of work because their employer goes out of business or downsizes their staff, when they need to care for sick family members, or when they face their own health challenges. People in low-paid jobs often don’t have access to sick leave, let alone family and medical leave for issues of longer duration, and so they become unemployed when unable to work.
And, because of restrictive unemployment insurance rules that don’t mesh with the low-paid labor market, many people who lose their jobs and are out of work temporarily don’t qualify for unemployment benefits, making access to food assistance and health coverage even more critical. Rather than recognize this reality, work requirements buy into inaccurate stereotypes based on race, gender, and disability status and ignore the instability of low-paid work, as well as ongoing labor market discrimination that also limits employment opportunities.
Burdensome and confusing work reporting requirements are another huge problem. They trip up both working people with administrative burden and red tape, as well as those with disabilities or health conditions who should be exempt but still have their benefits terminated.
And rigid work requirements don’t increase employment. As an example, Arkansas implemented a Medicaid work requirement in 2018, before courts struck it down for being contrary to Medicaid’s purpose. There was no evidence that the policy increased employment, but 18,000 people — 1 in 4 of those subject to the requirement — lost their health coverage. Given complicated reporting requirements, people with disabilities were “particularly vulnerable” to having their Medicaid coverage terminated. Similar efforts in other states also led to big barriers to health coverage. After assessing the evidence, the nonpartisan Congressional Budget Office concluded in 2023 that a proposed federal Medicaid work requirement would lead to coverage loss with no meaningful change in employment or hours worked.
SNAP, meanwhile, already has a harsh — and ineffective — work requirement. It limits non-elderly adults with no children in their home to only three months of benefits unless they document that they are meeting a 20-hour-per-week work requirement, are otherwise exempt, or live in an area for which the state has obtained a waiver based on its relatively high unemployment rate. Under this policy, food assistance is cut off for three years (unless someone manages to work their way through red tape to show that they should be exempt), even if an individual can’t find work.
In 2023 the SNAP work requirement was harmfully expanded to include older adults aged 50 through 54. While constructive exemptions were added for veterans, people experiencing homelessness, and certain former foster youth (both changes are in effect through fiscal year 2030), the expansion to older adults will mean that many people who have health challenges and struggle to find work will have their food assistance taken away.
As with Medicaid, studies have shown SNAP’s work requirement mostly just terminates people’s assistance, without increasing employment. One analysis found that the requirement cut SNAP participation among those subject to it by more than half, with no effects on employment. Any expansion of SNAP’s work requirement will result in more people needlessly losing vital assistance in buying food.
In considering new work requirement proposals in Medicaid, some have suggested focusing them first on working-age adults not raising children. This is an extreme proposal that would cause severe harm. Applying such a requirement would put Medicaid coverage at risk for tens of millions of people. There have also been suggestions to make the already harsh SNAP policy still harsher, with the result that even more adults would see their food assistance taken away.
Roughly 1 of every 2 people in the U.S. who lives in deep poverty — that is, whose income is below half of the poverty line — is a non-elderly adult who is not living with children and who does not receive disability benefits. That’s mostly because our current system of economic and health security programs does very little to help working-age adults without children. For example, while economic security programs reduce the number of non-elderly adults with minor children in poverty by 40 percent, these programs reduce poverty by only 8 percent for non-elderly adults without minor children. Pushing these adults into even more extreme hardship by taking away their health coverage or food assistance would be both cruel and counterproductive.
And many work requirement proposals in Medicaid and SNAP aren’t limited to adults without children — some would take away coverage from parents who don’t meet a work requirement. This jeopardizes parents’ health, the ability of families to afford food for parents and children alike, and parents’ access to the care they need so they can be attentive and supportive parents.
An agenda actually focused on promoting employment and helping workers would concentrate on expanding the Earned Income Tax Credit, increasing access to child care, assisting entry into work through subsidized jobs, and improving educational and training opportunities.