WASHINGTON — More than 10 million Medicaid enrollees would be subject to a “work requirement” under a new Republican proposal to cut federal spending in exchange for the government footing the bill.
Some Medicaid recipients will be able to meet the requirements and keep their health care coverage, but others will lose it, according to a new analysis from the Center on Budget and Policy Priorities, a liberal think tank.
Part of the problem is that even if they work enough hours to meet the requirements, some on Medicaid may struggle to document their work history with the government.
“A large portion of the 10 million people who comply with these requirements must navigate a complex reporting and verification system. monthly while others must navigate the periodic exemption process to operate the coverage,” center Gideon Lukens reported on Friday.
The work requirement was included in a broader bill released Wednesday by House Speaker Kevin McCarthy (R-Calif.) as part of a standoff with President Joe Biden over federal spending and the national debt.
This summer, the federal government could default on the bill unless Congress increases legal limits on how much money the U.S. Treasury Department can borrow. Governments must sell debt to cover expenses that exceed incoming tax revenue.
Republicans, led by McCarthy, say the $31 trillion national debt is too high and Democrats must agree to cut spending to slow debt growth. To that end, the bill calls for cuts among federal agencies, plus new limits on benefits for unemployed Americans who receive federal health and nutrition benefits.
The legislation is symbolic, as Democrats control the Senate and the White House, but the House passage will strengthen McCarthy’s hand in future negotiations with Biden.
“A large portion of the 10 million people who are subject to these requirements must navigate a complex monthly reporting and verification system, while others must navigate the periodic waiver process to maintain coverage.”
– Gideon Lukens, Center on Budget and Policy Priorities
The bipartisan Committee for a Responsible Federal Budget estimates that the proposed jobs rule would save the government about $100 billion over a decade, just about 2% of the total savings of $4.5 trillion.
Despite the relatively small effect on the federal budget, Republicans have highlighted the work requirement, suggesting that reducing support for healthy adults will keep them out of the workforce and make it easier for businesses to hire.
“Our plan is to ensure unaccompanied adults earn a living and learn new skills,” McCarthy said this week.
The Congressional Budget Office says work requirements in Medicaid and the Supplemental Nutrition Assistance Program have reduced benefits more than they have increased incomes.
Childless Medicaid recipients ages 18 to 55 must work 20 hours per week under McCarthy’s proposal or spend the same amount of time volunteering or in a training program. States must attempt to verify Medicaid recipients’ work, such as checking salary data, before asking individuals for verification.
One of the obstacles to passing the bill is that far-right lawmakers say the job proposal is not strict enough. Rep. Matt Gaetz (R-Fla.), for example, told reporters there that the requirement should be 30 hours a week instead of 20. But a stricter proposal will likely alienate more moderate Republicans. McCarthy has a slim margin and can lose the support of only four Republicans and still pass the bill.
Medicaid covers health care costs for 85 million low-income Americans, mostly the elderly and children, and most of whom have historically had no work requirements. Donald Trump’s administration allowed the state to test the work rule, and in 2018 about a quarter of Arkansas Medicaid recipients subject to the rule lost coverage.
In part by extrapolating from what happened in Arkansas, the CBO estimates that the national Medicaid work requirement would reduce enrollment by 2.2 million annually.