It's Not Clear How Many People Could Actually Work To Get Medicaid

Enlarge this image toggle caption Courtesy of Milken Institute School of Public Health Courtesy of Milken Institute School of Public Health

Republican House leaders are making last-minute changes to their health care proposal in a bid to woo more conservatives ahead of a vote scheduled for Thursday.

One of those changes would let states impose work requirements on some Medicaid recipients. A handful of states asked the Obama administration for that authority but were denied.

To further examine how requiring millions of Medicaid recipients to work could impact lives across the country, NPR's Audie Cornish spoke with Leighton Ku, a professor of health policy at George Washington University. The interview has been edited for length and clarity.

Interview Highlights

On whom this requirement could affect

The way it's written right now, it might affect millions of adults on Medicaid who aren't elderly, disabled or pregnant. They could be required to work to get their health insurance.

Among the people who enrolled in Medicaid under the expansion, about 13 percent might be considered able-bodied but not working right now. Of those, the great majority said the reason they weren't working was because they were taking care of family members. If you look across the nation, it might be millions of individuals who receive Medicaid benefits at the moment but potentially could be required to work under the rules Congress is considering.

On why requiring people to work to get Medicaid could prove problematic

Most Medicaid recipients want to work, and a majority of those on Medicaid [who can work] are already working. The problem is that many of them live in places where jobs aren't available or they don't have the right sorts of skills. Others have health problems or family obligations, or in some cases they're trying to better themselves in other ways like going to college.

If someone is going to college to get training so they can have a meaningful job later on, that doesn't count as meeting the work requirement in these policies. There are people who are trying to better themselves [but] have problems, whether related to work or family obligations, and this'll say, "You can't keep your health insurance anymore."

I disagree that this creates opportunity for people. People already had the opportunity to go look for work and get job training. This will actually disallow some of them to pursue other opportunities.

On how requiring work for health insurance differs from requiring work for food stamps

There are some work requirements in the food stamp program (SNAP). But that makes a little more sense in this context: If people work, they'll make more income and help make them economically self-sufficient. In the context of Medicaid, that makes less sense. Only a quarter of jobs available to people enrolled in Medicaid offer health insurance to their workers. It's not as though work requirements get them to the point where they'll be self-sufficient with respect to health insurance coverage.