Hook, Line and Sinker

If you’ve ever heard a child yell, “That’s not fair!”— you know how early that sense of justice kicks in. As adults, we don’t always say it out loud, but we still feel it. Whether it’s a coworker leaving early or being stuck with cleanup duty (again), we crave fairness — even when it’s not practical.

That desire for fairness can sometimes lead us to support policies that sound good but don’t hold water. Case in point: Medicaid work requirements. Let’s take a closer look.

Budget Bait-and-Switch
As Congress looks for ways to reduce federal spending to make room for tax cuts — many of which would benefit high-income households — Medicaid has become a target. But lawmakers know that fewer than 1 in 5 Americans want to see Medicaid funding reduced. Instead, they’re proposing “reforms”: rooting out fraud, penalizing states that offer coverage to undocumented immigrants, increasing eligibility checks, and imposing work requirements.

The proposed work rules would apply to nonpregnant, nondisabled adults without caregiving responsibilities, ages 19 to 64. These individuals would need to document at least 80 hours per month of work or approved activities such as job training or volunteering. Failing to meet the requirements — or to complete the necessary paperwork — could result in losing coverage.

Hooked, Then Humbled
On the surface, it feels fair. Shouldn’t that able-bodied guy living in his parents’ basement playing video games all day have to work for his benefits?

That’s what 62% of Americans think — at first.

But here’s the thing: most people on Medicaid who can work already do. In 2023, about 64% of adult Medicaid enrollees were working — 44% full-time, 20% part-time.
Of those not working:

• 20% were caregiving
• 12% had an illness or disability
• 10% were in school
• 8% cited other reasons, like retirement or being unable to find work

Work requirements don’t change that — they just add red tape. And red tape tangles people up.

Red Tape, Real Consequences
Once people learn that most Medicaid recipients are already working — and that people could lose coverage simply for missing paperwork — support for work requirements drops. Fast. From 62% to just 32%.

This isn’t hypothetical. In Arkansas, where work requirements were briefly implemented, more than 18,000 people lost coverage — not because they weren’t working, but because they couldn’t navigate the bureaucracy.

The Ripple Effect: Fewer Jobs, Not More
Despite the promise, work requirements don’t increase employment. But they do have big consequences.

If implemented nationwide, a recent study reports that up to 5.2 million people could lose Medicaid coverage by 2026. That could trigger nearly $59 billion in lost GDP and up to 449,000 jobs lost — not just in health care, but in sectors like construction, food service, and retail.

Medicaid plays a vital role in state economies. When enrollment drops, so does federal funding. Hospitals and clinics cut staff and services — or permanently close. Small businesses lose customers. Local and state budgets take a hit.

Work requirements may seem like a fair ask — but in reality, they strip coverage from people who are already working or facing real challenges. They don’t boost employment. Instead, they cost communities jobs, resources, and stability.

Sometimes the fairest thing we can do is make sure people get the care they need — without strings (or fishing lines) attached.

Happy reading,

Suzanne Daniels

Enjoy the weekend!

Best,
Suzanne
Suzanne Daniels, Ph.D.
AEPC President
P.O. Box 1416
Birmingham, MI 48012
Office: (248) 792-2187
Email: [email protected]