The Republicans’ “One Big Beautiful Bill,” a sweeping tax and spending bill, was passed by the House of Representatives May 22, and will likely be considered by the Senate later in June.
A major provision of the bill is the addition of work requirements to Medicaid, the health insurance program serving more than 71 million low-income Americans. The bill, with limited exceptions, would deny coverage to childless adults who can not prove that they work at least 80 hours per month.
This provision would do nothing to cut actual waste or fraud from the system, and serves only to pay for tax cuts for the billionaire class on the backs of the working class. The bill cruelly targets some of the most vulnerable members of society including those who are are unable to complete its onerous reporting requirements, shift workers with unpredictable hours and people with chronic medical conditions.
While President Trump has repeatedly stated that he will not cut Medicaid, insisting that he is only going after “waste, fraud and abuse,” White House advisor David Sacks stated that the bill would cut $880 billion from Medicaid over a decade.
If the administration really wanted to cut fraud and waste, it would be looking at the private insurance companies that manage most states’ Medicaid programs. Former Cigna executive Wendell Potter says that these companies are overpaid at least $84 billion per year. Using similar tactics to those used to bilk the Medicare Advantage program, these private insurers drive up costs while making it harder for working-class people to access care.
Public support for Medicaid cuts and a work requirement is mixed. A February KFF Health Tracking Poll found that while 62% of adults surveyed support work requirements for Medicaid recipients, a similar percentage also believed, incorrectly, that most working-age Medicaid recipients are unemployed. When informed that most adults on Medicaid are already working, this support dropped to 32%.
The right wing has long demonized Medicare recipients as being “lazy” or “getting something for nothing.” Ronald Reagan successfully used the racially charged “welfare queen” stereotype to imply that welfare recipients were lazy freeloaders, living the good life at tax-payer expense.
House Speaker Mike Johnson rolled out the same tired trope when, without evidence, he erroneously stated that “4.8 million able-bodied workers, young men, for example, … are on Medicaid and not working. They are choosing not to work when they can. That is called fraud. They are cheating the system.”
In fact as of 2023, 64% of adult Medicaid recipients aged 19 to 65 were working either full time (44%) or part time (20%), according to a separate KFF Study. Of those not working, 12% were not working due to caregiving responsibilities, 10% due to illness or disability and 7% due to school attendance. This leaves only 8% not working due to retirement, inability to find work or other reasons.
Approximately 46% of Medicaid recipients are not even of working age, with 36% being children and 10% being seniors, according to the American Hospital Association.
The Congressional Budget Office estimates that the bill would result in 7.6 million people becoming uninsured, many of them victims of red tape. When the Covid-era Medicaid eligibility requirements were unwound, most of the people losing coverage did so because of the law’s strict paperwork standards, not because they are actually ineligible. Writing in the New York Times, Matt Bruenig of the People’s Policy Project says that, “nearly 70% of disenrollments during this unwinding were the result of procedural snafus — i.e. failure to file paperwork — not the result of individuals being accessed as ineligible.”
In addition to burdensome paperwork, what makes this legislation so cruel and unfair is that the workers affected have very little control over the hiring, firing and scheduling decisions that not only affect their livelihoods but also their access to health care. USA Facts notes that, “Layoffs are a constant in the U.S. labor market.” In the first two months of this year, layoffs and discharges totalled 3.5 million, up 2.7% from the same time last year. Many of these laid-off workers rely on Medicaid for their health care, while they look for a new job. Hiring and firing decisions are made in the interests of the business owners not the workers.
Many low-wage workers also work unpredictable shifts. Just-in-time scheduling is used to match labor supply to customer demand, meaning that many workers are not guaranteed a minimum number of hours per week. This means that some months, workers’ hours may drop below the minimum required for benefits. As the Brookings Institution states, “Work requirements are intended to incentivize work among those who are able, but this assumes that individuals in need of assistance can control their own work hours.”
Several states have already tried establishing a work requirement for Medicaid eligibility. The first state to do so was Arkansas in 2018. A study published in Health Services, found that the work requirement resulted in a significant increase in uninsurance, especially amongst the lowest paid workers and those without internet access at home, without any corresponding increase in employment.
In states like Arkansas, with a large rural population, Medicaid cuts are especially dangerous. Medicaid is a critical lifeline keeping rural hospitals afloat and serving low-income communities. In rural communities, patients tend to be older and poorer. Medicaid provides health care coverage for more than 18% of non-elderly adults in rural America.
Many of the workers covered by Medicaid have chronic conditions such as cardiovascular disease or diabetes. Losing medical coverage would make it harder for these workers to find new jobs if their conditions go untreated, and would result in further financial hardship and premature death.
The KFF Health tracking Poll found that fewer than one in five adults (17%) actually wanted Medicaid funding to be decreased, with most saying it should either be increased (42%) or kept the same (40%).
Instead of gutting the safety-net programs that working-class Americans rely on to survive in order to fund tax cuts for the wealthy, we need a comprehensive health care system that covers all Americans. Even other capitalist democracies with single-payer systems have better health care outcomes at a fraction of the cost than the United States. However, if we want to move beyond safety-net programs, we need to fight for a socialist system that would guarantee that health care is a human right.
Photo: National Nurses United
