Medicaid Work Requirements: The Latest Front in Republicans’ Class War

This morning the Trump administration said that it would allow states to compel people to find work in order to receive Medicaid benefits. This is the first time in the over half-century history of the program that such requirements will be in place.

These requirements are bound to be disastrous for the poor, will likely increase poverty rates and negatively impact the health of our nation’s poorest citizens. As such it is the latest front in Republicans’ ongoing campaign of class warfare against the poor, the sick and the powerless. 

Proponents will point to the work requirements enacted in Bill Clinton’s welfare reform efforts in the 1990s as support for the move, ignoring the fact that those requirements were largely disastrous. While they may have boosted employment numbers among the poor at first, they did so by pushing people into unsteady, low-benefit, low-future jobs that did not last. Jobs that, to begin with, existed less due to anything in the reform measure than to the mid-late-90s economic boom which happened to occur at the same time. When that boom went bust people were forced out of those jobs and, with no welfare to fall back on anymore, found themselves on a lower rung of the economic ladder, in a worse off position than before. The only places where welfare work requirements experienced much if any success were in California and Oregon, where the requirements were married to robust and effective job training and placement programs, which were the exception, not the rule. 

Today the sorts of readily available jobs for people forced to find work for Medicaid are even MORE benefit-free and transitory, reflecting the overall gig economy ethos in playAt the same time, states administering Medicaid programs are highly unlikely to offer meaningful job training and meaningful opportunities for advancement to these people, because that itself is expensive and would undercut the overarching efforts to slash Medicaid costs. As it is, extra costs are going to be incurred by states trying to monitor and police employment compliance, so there’s no chance of real money being used to help people find good work. All of which is to say that, even if Republicans’ wildest fantasies are realized and there is an initial spike in Medicaid recipients working, it is unlikely to be meaningful, it is unlikely to last, and we’ll soon find ourselves with a lot of unemployed people who, unlike before, have no Medicaid coverage.  

This may make people like Paul Ryan happy — he is on record as having dreamed about slashing Medicaid since he was in college — but it’s immoral and cruel. What’s more, the impact of it all will go beyond harming the poor. It will harm society as a whole. 

When fewer people who need Medicaid have it, they will put off seeking primary medical care altogether and will only see physicians in serious or emergency situations. Most likely in hospitals’ emergency departments, where they will, quite understandably, not be turned away.  The twin effects of this are that (a) poor people’s health will decline, exacerbating alarming trends we’re currently experiencing like U.S. life expectancy decreasing for all but the wealthiest people; and (b) the costs of health care for everyone else will rise because someone has to cover the emergency care they receive. 

There have been studies upon studies regarding the failures and flaws of work requirement for  federal anti-poverty benefits such as welfare and Medicaid. The proposal announced by the Trump Administration this morning ignores them completely. This is not surprising, because the proposals are not about policy. They are about ideology and politics. An ideology which attributes moral weakness and failure to the poor and blames them for their plight. Politics in which bashing the poor and proposing to “get tough” with them, as if they are criminals, plays well with a certain set of often Republican-leaning voters, regardless of how morally bankrupt such messages are. 

A simpler way of putting it: this is class warfare, with the rich and powerful attacking the poor and weak. Which side of that war are you on?

Craig Calcaterra

Craig is the author of the daily baseball (and other things) newsletter, Cup of Coffee. He writes about other things at He lives in New Albany, Ohio with his wife, two kids, and many cats.