Start off with the fact that among the tens of millions of people on Medicaid, 93% of the working-age people enrolled are employed (63%), or they are caregivers, students, or unable to work due to illness. Just 7% of the non-working, non-elderly Medicaid population is unemployed. That includes people who can’t find work, or who have retired early because of care-giving duties, disability, or some other life reason.
Within that 7%, there are undoubtedly some people who just don’t want to work. But under this plan, the mechanisms states would be forced to set up to find these people and try to force them into jobs would cost far, far more than any potential savings. And there sure as hell aren’t enough of them to save Social Security and Medicare with their would-be payroll contributions.
The bill does not contain any assistance to states to set up the complicated systems necessary to track the tens of millions Americans who are on Medicaid. Medicaid is jointly funded by the states and by the federal government, and each state determines–within federal guidelines–eligibility for the program and some of the parameters of care that’s covered. This bill would force all 50 states to implement massive amounts of new red tape without giving them any funding to do. They would have to either kick people who fail to jump all of the bureaucratic hurdles out of the program, or pick up the entire cost of their health care.
The end result, which Republicans are absolutely counting on, would be millions of people becoming uninsured. They have proof of concept for that in a Trump-era experiment in Arkansas. That state was allowed, briefly, to impose work requirements on the people who gained insurance through the Affordable Care Act’s Medicaid expansion provision.
Georgetown University Medicaid experts Joan Alker and Edwin Park explain what happened next: “In just a few short months, 18,000 Arkansans lost coverage which equated to 23% of the group affected.” They point out McCarthy’s bill “goes farther than the Arkansas policy in numerous ways including applying the work reporting requirement to the entire Medicaid population, not just the expansion group, and not exempting the medically frail and people with disabilities on SSI.”
Get that? Medically frail people and people who have documented disabilities for which they are already receiving government assistance would have to go through all the motions of applying for work and proving that they’ve done so in order to keep their insurance.
Federal courts shut down the Arkansas experiment and the Biden administration revoked the federal waiver required for other states to implement it, but tremendous damage had already been done to Arkansans. A follow-up study by the New England Journal of Medicine found that “95% of persons who were targeted by the policy already met the requirement or should have been exempt.”
The real kicker? Every single study conducted found that it didn’t increase employment numbers at all. In fact, NEJM found that employment declined during the experiment “from 42.4% to 38.9% among Arkansans 30 to 49 years of age, a change of −3.5 percentage points.” Employment dropped in all the other age groups they looked at as well, from −2.9 to −5.7 percentage points.
It’s not about jobs. It’s not about the economy. It’s not about saving Social Security and Medicare. It’s about destroying Medicaid. They couldn’t repeal Obamacare, so they’ll go after the Medicaid expansion that has insured tens of millions of Americans. And if millions more lose their health insurance thanks to new requirements, new red tape, and more bureaucratic pain? To Kevin McCarthy and House Republicans, that is a feature, not a bug.
Markos and Kerry are joined by Aaron Rupar today to discuss what he is seeing in the right-wing media landscape. Rupar is an independent journalist whose Public Notice Substack is a must-read for those who want to know how truly outrageous the conservative movement is. We are addicted to his Twitter account, with its never-ending stream of Republican lunacy all captured on video.
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