Diving Deeper into Cynical Medicaid Work Requirements

Medicaid Politics
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            Marble Falls       The big, bad budget bill squeaking through the Republican-controlled US House of Representatives committee process makes a big thing out of work requirements as a means to transfer benefits from the poor to the rich by blocking access to Medicaid, food stamps, and other vestiges of what’s left of the US safety net.  These requirements are ideological, cynical, and controversial.

The Republican majority has no question that they are playing with political fire.  The work requirements for Medicaid for example are not scheduled to go into effect until January 2029, after Trump’s term of office ends, allowing them to say to President Trump that they have not restricted Medicaid, while both providing cover for electorally endangered Republicans and passing the hot potato over to the Democrats, who are thought likely to prevail then, or, if not, to a Republican majority that has become more embedded, rather than marginal.

The cynicism of all of their political spinning is rooted in their claims to be advancing the Protestant ethic of work by casting recipients of the health care support from Medicaid as rife with malingers.  Matt Bruenig, the labor lawyer who is the invaluable source of updates on NLRB cases and decisions and also the founder of the People’s Policy Project, engaged in some helpful debunking in a recent op-ed.

First, he makes the incontestable point that a lot of what puts workers on the street is based on employers’ decisions and actions, not on a worker’s pursuit or resistance to working.  It’s bosses who make the “hiring, firing, and scheduling decisions.”  They direct layoffs and firing that that added up to “20 million workers” in 2024.

He also makes another extremely valid point about the scheduling of hours for lower waged workers which can move them from full to part-time by a computer stroke forcing them under the 80-hour cutoff the bill wants to mandate for Medicaid.  When we were organizing Walmart workers we saw this everywhere.  Despite the company’s claim that local store managers made the decisions, the data driving the scheduled hours came from Bentonville, Arkansas computers predicting buyer ebb and flow.  A worker’s schedule could drop from 32 or 40 hours one week to 16 the next without notice, pushing someone full-time one month to less than half-time the next.

Then, there’s just the facts, ma’am:

  • “According to Census Bureau’s current population survey 46% of Medicaid beneficiaries are children or people age 65 and older that are not expected to work.”
  • “Of the working-age beneficiaries, about half are working…”
  • “…an additional quarter have a work-limiting disability”
  • “An additional one-fifth will work at some point in the next year or come off Medicaid sometime in the ensuring 15 months.’
  • “…only 6% of working-age enrollees are not engaged in work long term, which is just 3% of the entire Medicaid populations.”

As Bruenig makes clear, and as most of us in this field know, this is a fictional fix for a reality that does not exist.

This is not about pushing more people into employment.  Trial runs of these kinds of draconian work requirements in places like Arkansas pushed 18,000 off the rolls because bureaucratic and paperwork problems, not illegibility, and there was no finding of an increase in employment.  More people were manufactured poorer thanks to punitive government action.  Another tragic example of pushing off eligible families who are not as technically or paperwork abled that Bruenig cites, come from the post-Covid Medicaid pushout…

…as Covid rules were reversed, states sent out notices directing beneficiaries to submit paperwork to recertify their Medicaid status.  Nearly 70% of the disenrollments that occurred during this unwinding were the result of procedural snafus – not the result of individuals being assessed as ineligible.

The fight isn’t over, but there has rarely been a more devastating and painful example where the ways – continuing benefits for the rich – are being achieved through scurrilous means — pretending fiscal responsibility and punishing the poor.

These are public policies, but punitively weaponized policies in the ongoing war against workers and the poor in America.

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