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The White House claims that the One Big Beautiful Bill, the president’s main second-term domestic policy, does not reduce Medicaid. However, numerous budget experts, including those from Congress, argue that it severely cuts the health program, slashing $1 trillion in funding and stripping coverage from 10 million individuals.
To reconcile this discrepancy, the White House has resorted to a simple solution: deception. They argue that a trillion-dollar reduction is not really a cut; removing health insurance from 10 million people does not equate to shrinking the program. They also deny certain statements made by the president and vice president-elect, distorting reality to fit their narrative.
Other Republicans have adopted a more complex form of explanation. The legislation enforces a national work requirement for Medicaid recipients, where able-bodied adults must demonstrate employment, volunteer work, or enrollment in school in order to receive coverage. Speaker Mike Johnson stated on CBS that refusing to work when able is considered defrauding the system, emphasizing a moral justification for the new law. They argue that the legislation does not reduce Medicaid but safeguards it from misuse.
However, these justifications are as misleading as the White House’s lies. The work requirement for Medicaid will not enhance the program, boost the job market, or remove lazy individuals from welfare. Instead, it will burden taxpayers with additional costs and subject low-income Americans to hours of unnecessary paperwork. The bureaucratic hurdles may result in millions losing healthcare access, leading to dire consequences for some. The Republicans are not safeguarding Medicaid but rather risking the lives of their own constituents.
The rationale behind imposing a work requirement on Medicaid recipients is often framed as preventing the safety net from becoming a lifestyle choice, as many Republicans claim. Yet, most Medicaid beneficiaries who can work are already doing so. Unlike other government assistance programs, Medicaid does not provide cash benefits. The argument that the work requirement will encourage employment is unfounded, as demonstrated by research.
The Kaiser Family Foundation reports that a majority of nondisabled adults on Medicaid are employed, while the rest face barriers such as health issues, caregiving duties, or limited job opportunities. The small percentage of individuals potentially affected by the work requirement are not freeloaders but rather retirees or those facing economic challenges. Therefore, the work requirement is better understood as a reporting obligation. By 2027, recipients will have to detail their daily activities to retain access to essential health services.
In conclusion, the Medicaid work requirement proposed by Republicans is not a solution to boost employment but rather a burdensome measure that may harm vulnerable individuals and strain state resources.
The goal is to develop, test, and implement a complex intake and verification system within a tight 18-month timeline—effectively only six months, as detailed guidelines from the Department of Health and Human Services are not expected until the middle of the following year. A 2019 report from the Government Accountability Office revealed that states had previously spent up to $463 per beneficiary to establish similar systems. Currently, Georgia, the lone state with a Medicaid work requirement, incurs $9 in administrative costs for every $1 spent on medical care under this program.
Over 20 million Americans will need to create accounts to indicate their compliance status with the work requirement, whether they are non-compliant, or exempt from it. This process will likely involve submitting documents, waiting for verification, sharing sensitive personal information, and potentially appealing incorrect decisions on what is anticipated to be an inefficient and understaffed system managed by overloaded civil servants. A simple technical glitch or an unreliable internet connection could result in rejection, while a missed communication from a caseworker might cause someone to miss out on essential care. Essentially, the burden of public administration is shifting to individuals, with an expectation that many will struggle.
In practice, work requirements tend to filter out eligible participants more effectively than motivating those who are not in compliance. In Georgia, approximately 240,000 individuals qualify for the state’s work-for-Medicaid program designed for very poor, non-disabled adults, yet only 5,500 are enrolled due to the program’s convoluted rules and dysfunctional online platform. Arkansas removed nearly 20,000 people from Medicaid when it mandated proof of employment in 2018 and 2019, yet this did not impact employment rates. An analysis of a significant legislative bill suggests that each proper disenrollment from Medicaid will incur approximately $5,000 in administrative costs, not far from the program’s initial per-person expenditure.
The current legislation put forth by the Trump administration does not safeguard Medicaid. It demands Americans to spend countless hours each year on arduous and unnecessary paperwork, leading to millions losing their health insurance coverage, restricting access to care, and plunging individuals into debt. It is estimated that around 50,000 people will perish annually due to bureaucratic hurdles.
