Between 61,000 and 183,000 low-income residents of Michigan are likely to lose government-provided health insurance next year, thanks to new Medicaid rules the state Republican legislature passed last summer and that the newly elected Democratic governor now wants those lawmakers to amend. The changes apply to people who got Medicaid because of Michigan’s expansion of the program, in 2014, when the state tapped federal dollars available through the Affordable Care Act and opened enrollment to anybody with income below or just above the poverty line. Under new requirements set to take effect in January 2020, those beneficiaries must demonstrate they are working at least 20 hours a week, trying to find work or unable to work. Supporters, including GOP leaders in the legislature, say the new requirement and reporting regimen will encourage people to find jobs ― and that, more fundamentally, it’s wrong to demand taxpayers subsidize health care for people who could find employment but don’t. But most people who got coverage through the Medicaid expansion are either working already or cannot hold jobs, because they are caring for others or have serious conditions of their own, studies have shown repeatedly. And in Arkansas, which imposed work requirements last year, more than 18,000 people lost their coverage for failing to comply. If local reporting and available data are indicative, people aren’t generally losing coverage because these people actually failed to meet the work requirement or lack qualifying hardships. Instead, they are losing coverage because they had difficulty navigating the complex reporting requirements. Advocates for the poor worry the same thing will soon happen in Michigan, only on an even larger scale, and that it probably won’t stop there.

ASSOCIATED PRESS Gretchen Whitmer, Michigan's newly elected Democratic governor, is urging the GOP state legislature to roll back Medicaid work requirements slated to take effect next year.

The federal Medicaid law, which dates back to 1965, requires that states seeking major changes get special permission from the federal government. The Obama administration looked askance at work requirements on the theory that they could harm beneficiaries, which would be a clear violation of the Medicaid statute. The Trump administration has taken a different attitude, approving seven such applications, including Michigan’s, with another eight now pending. Seema Verma, chief administrator of Center for Medicare and Medicaid Services, has been a vocal proponent of the work requirements ― arguing last year that they are “not some subversive attempt to just kick people off of Medicaid … their aim is to put beneficiaries in control with the right incentives to live healthier, independent lives.” But there is scant evidence that work requirements encourage people to find employment. If anything, the evidence suggests the opposite ― that Medicaid coverage makes it easier for people to find and hold on to jobs, most likely because they don’t have to worry about medical problems that would make work difficult. Of course, it’s not clear how much the Trump administration cares about what happens to the people who lose Medicaid ― or whether it cares at all. Among the first states to get the administration’s go-ahead for work requirements, not a single one of them had created systems for checking whether people losing coverage end up in better jobs or with better health, according to an investigation that the Los Angeles Times published this week. In fact, it’s hard to look at the requirements and not see them as part of a broader, more general assault on government-financed health insurance ― an assault that is still ongoing, all across the country, even though GOP efforts to repeal “Obamacare” were perhaps the single biggest reason Republicans suffered such a devastating rebuke at the polls in the midterm elections. Michigan, a state that was pivotal in Trump’s 2016 presidential victory, was actually one of the states where Republicans fared worse. They lost a pair of closely contested congressional races along with the top statewide offices, up to and including governor. Gretchen Whitmer, the state senator who would eventually win that contest, attacked her GOP opponent for supporting repeal of the Affordable Care Act. She also touted her role in getting the Medicaid expansion through the state legislature.

The Washington Post via Getty Images Seema Verma, who oversees Medicaid for the Trump administration, has urged states to impose work requirements on Medicaid — and approved several applications to do so.