Make America Unhealthy (to pay for yet another upper-class tax cut) Again

The House Republicans are proposing savage cuts to Medicaid:

A 7.6 million increase in the number of uninsured Americans would represent a massive jump, equivalent to about 30 percent of the total uninsured population today.

And even that data point doesn’t fully capture the impact of what Republicans are proposing—in part, because it’s not just the newly uninsured who would feel it. Plenty of other people would, too, so with a key House committee about to start deliberations—and kick off weeks’ worth of debate—now would be a good time to look closely at who they are.

WHEN YOU THINK OF MEDICAID, you probably think of poor children and working-age, able-bodied adults. But about one in four Medicaid beneficiaries are either elderly or people with disabilities.

Most of them have Medicare, which covers most of their ongoing medical expenses. But Medicare has some big gaps in coverage, including big out-of-pocket expenses for doctor visits, hospitalizations and prescription drugs. Plus there are some expenses, like long-term care, it doesn’t cover at all.

Low-income seniors and people with disabilities can get Medicaid to fill in those gaps. And it would be difficult to overstate how vital that Medicaid coverage is for these people, given the frailty of the population in question and their limited, sometimes nonexistent financial resources. Among other things, Medicaid is the single largest payer of nursing-home care.

But the vulnerability of this population means many of them are particularly ill-equipped to handle the procedures of enrolling and then staying on Medicaid. For that reason, the Biden administration used its regulatory authority to streamline the process, by (for example) requiring less frequent checks of eligibility and more seamless procedures for switching between government plans.

The administration is trying to preempt criticism of this appalling and extremely unpopular proposal by sending the celebrity cranks it’s put in charge of public health to tell whopping lies about it in the Paper of Record:

Supporters depict work requirements as a matter of fairness and proper incentives. In a New York Times op-ed published this morning, the Trump-administration officials Robert F. Kennedy Jr., Mehmet Oz, Brooke Rollins, and Scott Turner define Medicaid as “welfare” and blame it for luring people into dependency and sloth. “Millions of able-bodied adults have been added to the rolls in the past decade, primarily as a result of Medicaid expansion,” they complain. “Many of these recipients are working-age individuals without children who might remain on welfare for years. Some of them do not work at all or they work inconsistently throughout the year.”

What this claim is hiding behind weasel words (many, some) is that, according to a recent academic study based on U.S. census data, a mere 8 percent of Medicaid recipients are able-bodied, working-age adults who don’t have jobs.

RFK Jr. and his co-authors don’t spell out precisely how work requirements are supposed to get their imagined Medicaid queens off the couch, but the implication is that the threat of removing free health care will prod these slackers into finding a job. (“We believe that work is transformative for the individual who moves from welfare to employment,” they write.) But note that the expected fiscal savings depend on the get-a-job requirement not working. If every Medicaid recipient duly secured or sought work to the government’s specifications, then they would keep their Medicaid benefits, and the requirement wouldn’t cut spending. (Yes, some folks who got jobs would receive employer-provided health coverage, but many would still need Medicaid, because many low-paying jobs don’t come with insurance.)

What actually will happen, however, is very different. The work requirements will create complex reporting demands that lead eligible Medicaid recipients—people who have jobs, or care for their children, or cannot work—to lose their health care.

This is not speculation. We know how Medicaid work requirements play out because the policy has been tried at the state level. Arkansas, for example, implemented work requirements in 2018. Researchers found that they utterly failed to encourage more employment among the Medicaid population. The work requirements instead forced Medicaid recipients to navigate endless, complex paperwork demands that many of them couldn’t understand or keep track of, causing them to lose their Medicaid eligibility. The bulk of the savings came from denying coverage to eligible Americans, not able-bodied adults who don’t want to work.

Georgia tried its own version of work requirements in 2023 and experienced even more extreme failure. Under its Pathways to Coverage program, the state expanded Medicaid eligibility, but forced recipients to verify their employment status or participation in other qualifying activities, such as volunteering or job training. After one year, just 4,231 Georgians had enrolled, about 2 percent of the eligible population. Incredibly, Georgia spent five times as much on the system to verify their eligibility as it did on their health care.

AOC provides a model for pithily explaining the cynicism at work to hide the horrifying consequences of the plan here:

Republicans are saying that these cuts will be reinvested into Medicaid for people who "deserve" it. If that were true, the budget would stay the same. But that's not what's happening. Why? Because down the hall, they are trying to finance tax breaks for billionaires.

[image or embed]— Rep. Alexandria Ocasio-Cortez (@ocasio-cortez.house.gov) May 14, 2025 at 1:00 AM

This is how to do it.