Why Medicaid Work Requirements Are A Bad Idea
25:16 Share

It's Wednesday, May 21st. I'm Jane Koston. This is What A Day, a show that recalls a time when congressional hearings for members of a presidential administration involved way less screaming. It's crazy, but it's true. On today's show, Secretary of Homeland Security Kristi Noem gets her constitutional rights all mixed up during a Senate hearing. And Trump's FDA looks to limit access to COVID booster shots. But let's start with Medicaid.

We've been talking about Medicaid a lot on this show. As a refresher, it's the health care safety net program that primarily covers low-income Americans, and it's jointly run by the federal government and states. It's also in the crosshairs of congressional Republicans, as they try to move President Donald Trump's big, beautiful bill slowly, painfully, through the House and Senate and onto his desk.

They're eyeing upwards of $800 billion in cuts to Medicaid over the next decade. And one of the ways they want to do that is by imposing new work and eligibility requirements. But if you're just listening to Trump talk, you'd honestly never know it. Because the president seems to be very into Medicaid. Here he is Monday at the tail end of an unrelated press conference in the Oval Office. Thank you, President. No cuts to Medicaid. No cuts to Medicaid. Thank you.

And earlier in the day, Trump went to Capitol Hill to strong-arm Republicans into passing his big legislative agenda. And he reportedly told lawmakers, quote, don't fuck around with Medicaid. But despite Trump's efforts to use the power of positive thinking and mob boss threats to change the minds of the GOP, inspirational to me, really.

Republicans are, in fact, fucking around with Medicaid. All that money for tax cuts has to come from somewhere. Why not poor people's healthcare coverage? Am I right? And I've been noticing something. Despite the fact that Medicaid covers more than 70 million Americans, it appears many people, including a ton of Republicans, don't seem to know much of anything about the people on it. For example, here's Florida Republican Senator Rick Scott on Fox News. If you don't want to work, you're the one that decided you don't want healthcare.

That's number one. Number two, Medicaid is supposed to be for children that don't have health care.

and people with chronic illness. Also for eligible low-income adults to quote Medicaid's own website if we're picking nits here. And here's Louisiana Republican Representative Steve Scalise on CNBC. If somebody's able-bodied and they can go get a job and they're living in their mom's basement playing video games, I'm sorry, you got to go get a job. This program was designed for the truly needy, the disabled people, pregnant women, seniors. And

And eligible low-income adults. Why do they keep forgetting that part? Anyway, based on how those two titans of Congress talk about Medicaid, it's not surprising that many Americans support work requirements for the people on it.

But here's the thing. Most working-age adults on Medicaid work. According to data from the nonpartisan health research firm KFF, nearly two-thirds of adults covered by the program were working in 2023. And most of those who weren't were caregiving, managing illness or disability, or were in school. Perhaps Senator Scott and Representative Scalise aren't being intellectually honest with the American people about their plans that could cost an estimated 10 million Americans their healthcare coverage? According

According to the nonpartisan Congressional Budget Office, no. What? No. So to learn more about work requirements for Medicaid and why they are a not very good idea, I spoke with Matt Bruning. He's the founder of the People's Policy Project, a think tank focused on social and political equity issues. And he wrote a recent New York Times op-ed titled Medicaid Work Requirements Are Cruel and Pointless.

Matt, welcome to What A Day. Oh, thanks for having me. Okay, so before we get into the moral and practical reasons you oppose work requirements for Medicaid, can you explain how they would work in theory as laid out in this Republican spending plan that's being debated right now?

In theory, every month you're going to tell the state Medicaid agency how many hours you worked. And if you're above 80, then you can continue to receive benefits. And if you're below 80, you will be cut off of benefits. That is if you're otherwise non-disabled, not a child, not old. You know, after you clear those bars, you have to clear 80 hours a month of work.

Right. So who would this apply to? Because there are a lot of people who obviously are receiving Medicaid, who are taking care of a sick parent or might be in school. So it wouldn't apply to those people, correct?

It could apply to someone in school. But yeah, when you think about the entire Medicaid population, about half our children are elderly, so they're not going to be affected by it. Then of the remaining half, about half of those are working. And then another quarter are disabled and so on and so forth. But, you know, the main population is going to be somewhere around,

Maybe about 20% of the working age population who are on Medicaid could end up getting dinged one way or another by it. Broadly speaking, work requirements for government aid are popular. A recent poll from the nonpartisan research firm KFF found that close to two-thirds of Americans back them, including nearly half of Democrats. So why is it broadly popular?

Yeah, so that poll actually asked a second question where they confronted people with the low amount of people who are on these benefits who are out of work and on a long-term basis. And when you tell people, oh, actually, there really aren't that many people who are just persistently out of work on Medicaid or food stamps or whatever.

then the support for the work requirements goes down, actually below 50%. So what that seems to suggest is a lot of people just think that the Medicaid rules are just full of unemployed people who just persistently don't work. And this has kind of been a trope in welfare policy for ever and ever and ever.

Right, right. I think that Reagan's welfare queen is probably the most famous example of that. But you're hearing that a lot right now this week of Republicans talking about how there are all these unemployed dudes living in their basements who are not working and don't want to work. And that's why we have to have work requirements. But given the level of federal spending on Medicaid, more than $600 billion in fiscal year 2023, are work requirements not a better middle ground than, say, finding savings by cutting parts of the program, which voters do not want?

Yeah, I mean, I don't know. When you start deciding what you want to cut from it, I'm not sure. It's all very important. I think one of the issues with work requirements is that it's going to ding a lot of people that you don't expect to ding. So even if you want to say, well, there's got to be at least some people on the rolls who...

are these basement dwelling video gamers who just refuse to work. There's 330 million people in the country. There's got to be some, there just have to be. Your ability to locate those people in a systematic way and call them from the roles is very, very limited.

And what you'll end up doing is you're going to end up hitting a lot of people who you don't expect to hit. In fact, probably far more people that you don't expect to hit than the people who you're trying to get off the roll. So to me, increasing administrative burdens in this way, that's just going to kind of create a sort of random assortment of people who mostly just can't report their hours accurately is not a good way to go.

Yeah, I think that that gets us into the moral and practical reasons why you say work requirements for Medicaid don't work. And the main argument you lay out in your New York Times op-ed is that Medicaid was designed to be a backstop for people who are out of work. Can you explain that a little bit more? Yeah, I mean, when you think about in the post-Obamacare health care system that we have, if you're employed, you typically get employer-sponsored insurance, or maybe not, you can get an Obamacare exchange plan.

And if you lose your job, well, now you don't have income. The only place for you to go is Medicaid. And so there's something a little contradictory about saying, well, we want to get all these people who aren't working off of Medicaid. That's where you go when you aren't working. You know, I've lost a job before and I was unemployed for two or three months.

There's nowhere else to go. You can't buy an exchange plan. You can't get Medicare. You're not old enough. I'm not a veteran. I can't get TRICARE. That's the only place in the system to go. So unless you're basically saying, hey, when people lose their jobs, we just don't want them to have health insurance. This kind of plan doesn't make sense.

And as you mentioned, too, it's also true that a lot of people who rely on Medicaid do have jobs. Their employers may just not provide health insurance or they don't work enough hours every week to qualify for it. So even though they're not nominally affected by these work requirements, what would imposing them mean for their ability to maintain them?

Yeah, no, they have to now start reporting their hours. And that's not a thing you do already in the system. You do have to kind of report your earnings periodically to make sure that you're still below the income cutoff, but you don't report hours. And there's really no other place that we report hours except employers will report your hours either quarterly or annually to the state unemployment office.

But the idea of reporting it every month or having to separately report it to the Medicaid office, which is going to be your obligation, not the obligation of your employers, that's not something that exists. So you may not even be able to get it. I think about someone who's an Uber driver, for instance. I know Uber drivers who are on Medicaid. Right.

How many hours do they work? I don't know. I mean, their rides are timed, but obviously they spend a lot of time dispatching. Driving in between rides or something like that. Yeah, so what's an hour for an independent contractor? What's an hour for a handyman, for someone who mows lawns, for someone who paints houses, for someone who cleans? These things are, how do you prove these things?

Yeah. And it just goes to Republicans argue these requirements will push more people into the workforce. But as we've been talking about, a lot of these people are already in the workforce. And you say, quote, work requirements are a solution to a problem that doesn't exist. Can you explain what you mean there?

I mean, the supposed problem is that there's a lot of people who just persistently sit on Medicaid who are able-bodied adults who don't have dependents. And that just isn't true. The numbers that I came up with at the current population survey is that about that describes about 3% of all Medicaid recipients. And that's without even looking into those recipients. Some of those are college students. They might have some extenuating circumstances. Who knows?

It's just not a huge issue. The only way it's going to save benefits is by hitting other people who you don't intend to actually kick off the program, people who will fail to report their hours correctly. Now, a handful of states have tried to impose these work requirements. Arkansas, Georgia, what did they find? Did they find all these savings that Republicans are now promising? Because it sounds like no.

No. I mean, in Trump 1, they put out a rule saying that states would be given waivers to implement work requirements. Arkansas took advantage of that waiver, implemented it, and kicked off 18,000 adults in four months.

Subsequently, a judge halted it and said they couldn't do it. But during that period, they removed those adults and that created a obviously very fertile environment for researchers to go in and say, well, what happened to those adults? What happened to employment in Arkansas? We can compare it to all these other states that didn't impose it. And they find no impact on employment. So if this bill makes it to President Trump's desk, and that is a giant if, what would it mean for the more than 70 million Americans who were enrolled in Medicaid?

I mean, for most of them, it's going to just be a huge hassle. A lot of people will be cut off the rolls, you know, and then they'll have to turn around and fight to try to get back on them. And now you're in a situation where, you know, if a medical emergency hits you or some kind of or if you're dealing with some kind of chronic illness, which is probably the worst case scenario, you're just you're just going to be out of luck. You're not going to be able to

to afford healthcare. And I mean, people will die, honestly. I mean, that's the bottom line here. People will die and others will suffer. Matt, thank you so much for your time. Thank you.

That was my conversation with Matt Brunig, founder of the People's Policy Project. We'll link to his op-ed in The Times in our show notes. We'll get to more of the news in a moment, but if you like the show, make sure to subscribe, leave a five-star review on Apple Podcasts, watch us on YouTube, and share with your friends. More to come after some ads.

What a Day is brought to you by ZBiotics Pre-Alcohol. Let's face it, after a night with drinks, I don't bounce back the next day like I used to. I have to make a choice. I can either have a super fun night or a great next day. That is, until I found pre-alcohol. ZBiotics Pre-Alcohol Probiotic Drink is the world's first genetically engineered probiotic. It was invented by PhD scientists to tackle rough mornings after drinking.

Here's how it works. When you drink, alcohol gets converted into a toxic byproduct in the gut. It's a buildup of this byproduct, not dehydration, that's to blame for rough days after drinking. Pre-alcohol produces an enzyme to break this byproduct down. Just remember to make pre-alcohol your first drink of the night, drink responsibly, and you'll feel your best tomorrow. Every time I have pre-alcohol before drinks, I notice a difference the next day. Even after a night out, I can confidently plan on working out or going for a run without worry.

Spring is here, which means more opportunities to celebrate warmer weather. Before drinks on the patio, the tropical vacation, or your best friend's wedding, don't forget Z-Biotics pre-alcohol. Drink one before drinking and wake up feeling great the next day. Go to zbiotics.com slash wad to learn more and get 15% off your first order when you use code WAD at checkout. Z-Biotics is backed with a 100% money-back guarantee, so if you're unsatisfied for any reason, they'll refund your money, no questions asked.

Remember to head to zbiotics.com slash WOD and use the code WOD at checkout for 15% off. Summer on the south side of Chicago is heating up. You planning revenge? On two. This Chi is back on Paramount+. Hi.

It's the season of the women. Women, this is our chance. It's time to get to work. But the men aren't giving up without a fight. The tree's always going to have a bill. No one is backing down in the Showtime Original Series from Emmy Award winner Lena Waithe. Why do black women always have to save the day? If we don't do it, who else will? The Chi, new season now streaming on the Paramount Plus with Showtime Plan.

Next level pet people will do anything for their dogs. That means treating them with next level protection from parasites with Next Guard Plus, a Foxelon or Moxidectin and parental chewable tablets. Next Guard Plus chews provide one and done monthly protection against fleas, ticks, heartworm disease, roundworms and hookworms, all in a tasty beef flavored shoe. Used with caution in dogs with a history of seizures or neurologic disorders. Dogs should be tested for existing heartworm infection prior to starting a preventive.

Ask your vet about NexGuard Plus Choose. Here's what else we're following today. Head of line. Secretary Noem, please stand and raise your right hand. Do you swear the testimony you will give before this committee will be the truth, the whole truth, and nothing but the truth? So help you God.

Secretary of Homeland Security Kristi Noem testified before the Senate Committee on Homeland Security and Governmental Affairs on Tuesday. She was there to discuss her department's 2026 budget. Noem also performed a masterclass in attempting to fake it till you make it when she was asked by Senator Maggie Hassan of New Hampshire to define habeas corpus. Secretary Noem, what is habeas corpus?

Well, habeas corpus is a constitutional right that the president has to be able to remove people from this country. No, no, no.

Unfortunately for Secretary Noem, Senator Hassan appears to actually know the definition of the term habeas corpus. Excuse me, that's incorrect. President Lincoln used it. Excuse me. Habeas corpus is the legal principle that requires that the government provide a public reason for detaining and imprisoning people. If not for that protection, the government could simply arrest people, including American citizens, and hold them indefinitely for no reason.

You know, that's the constitutional right your department is accused of violating in its draconian immigration crackdown, Madam Secretary.

Senator Hassan's question to Noem came in response to remarks made earlier this month by White House Deputy Chief of Staff Stephen Miller, who said that the White House was actively looking at suspending habeas corpus as part of the Trump administration's mass deportation efforts. Noem did talk some business of the hearing. She was questioned by multiple senators about the Trump administration's nearly $500 million in proposed cuts to the Cybersecurity and Infrastructure Security Agency, or CISA.

Noem remained vague on how exactly the cuts would be achieved, instead echoing comments she's made previously insinuating that CISA is responsible for political censorship and that the agency needs to get, quote, back on mission. We were third in space and now we're number one in space by a lot. It's not even close.

During a Tuesday afternoon press conference in the Oval Office, President Donald Trump announced a major defense project that is intended to protect the U.S. from missiles launched from all over the globe and even space. Trump, famously a lover of gold, is calling it the Golden Dome. And of course, it will be, quote, the best system ever built. The president estimated that the total cost of the project will come to $175 billion, $25 billion of which would be set aside in his one big, beautiful bill. Trump

Trump also announced that Space Force General Michael Gutlein would head up the project. Last month, it was reported that Elon Musk's SpaceX is among the frontrunners to win a lucrative contract in the construction of the Golden Dome. This is very important for the success and even survival of our country. It's a

Pretty evil world out there. Now, it's worth noting that according to reporting from the New York Post, SpaceX would want the Golden Dome to operate as a subscription service that the government would pay for access to. Like Netflix, but for missile defense. Sure. We've seen this administration come after and attack, you know, leaders for doing their jobs. It's political intimidation, and I will not be intimidated. I expect to continue to do my job.

Democratic Representative LaMonica McIver of New Jersey is facing charges for allegedly assaulting two federal agents outside a migrant detention facility while trying to block the mayor of Newark from being arrested. McIver was part of a congressional delegation visiting the Delaney Hall facility in Newark, where Immigration and Customs Enforcement had begun holding detainees. In a complaint made public Tuesday, the government alleges McIver assaulted Homeland Security and ICE agents while protesting the arrest of Mayor Ross Baraka.

Interim U.S. Attorney for the District of New Jersey, Alina Haba, announced the charges in a statement shared on Twitter. She said Baraka's misdemeanor trespassing charge was dismissed for, quote, the sake of moving forward. But Haba said McIver's conduct can't be overlooked. In a statement, McIver said, quote,

The truth is that for many Americans, we simply do not know the answer to whether or not they should be getting the seventh or eighth or ninth or 10th COVID-19 booster.

FDA vaccine chief Dr. Vinay Prasad announced on Tuesday that the agency will no longer provide universal access to annual COVID boosters. In a major policy shift, the FDA is raising the standard of proof required to approve the shot for healthy Americans between six months and 64 years of age. Until now, new COVID boosters were approved annually by the FDA when manufacturers could show that the latest version provided as much immune protection as the previous year's version. Now the FDA is trying something new with your health.

It's requiring new randomized control trials to prove that the COVID vaccines are still safe and effective before approving them for most Americans. Dr. Prasad said that vaccine approval for older adults and those with high risk factors would remain streamlined. Dr. Prasad has been an outspoken critic of the FDA's response to the COVID-19 pandemic. In a 2021 blog post, he suggested that the federal government could use the pandemic as an excuse to end democracy and stand up a totalitarian regime in the U.S.,

And that's the news. One more thing.

What exactly does Health and Human Services Secretary Robert F. Kennedy Jr. do all day? Swim in jeans? Swim in jeans in a creek of human sewage? Eat French fries cooked in tallow? Because whatever it is he does, it definitely doesn't seem to be managing the day-to-day operations of the Department of Health and Human Services. Case in point. On Tuesday, Kennedy appeared before the Senate Appropriations Subcommittee to discuss Trump's 2026 budget request for the agency he allegedly runs.

I say allegedly, because when questioned by Illinois Democratic Senator Dick Durbin about cuts to ALS research and the effects those cuts would have on one of his constituents who's been diagnosed with the disease,

Kennedy appeared to have absolutely no idea what the hell was going on in his own damn department. How can we possibly address his concerns and give hope to people across the country who are suffering from so many diseases when our government is cutting back on that research? As I said, Senator, I do not know about any cuts to ALS research, and I'm happy to meet with you. I just read them to you.

I will have to go and talk with Jay Bhattacharya and find out what the rationale was for those cuts. I just don't know about them until you told me about them at this moment. Yes, do that, please.

Here's why this drew my attention. A month ago, my mom died. You may have known that. You may not have known that she died of amyotrophic lateral sclerosis, also known as ALS, sometimes called Lou Gehrig's disease. Here's what ALS did to my mother. It stole her ability to speak first, slurring her speech and then making it impossible for her to talk altogether, which was hard because my mom loved to talk to anyone and everyone.

ALS then made it so she couldn't swallow easily, making it difficult and very embarrassing for her to try to eat in front of other people. And then ALS made eating impossible. And my mom loved food, both cooking and eating. I used to tell her it was too bad the Third Amendment existed because she would have really enjoyed cooking for an entire army garrison stationed in her house. She got a feeding tube installed in November. She hated it. My mom loved to swim. She could spend hours in the pool my dad built for her the summer I was born.

But because of ALS, she lost so much weight and so much muscle that she couldn't swim anymore. She started falling, stopped being able to walk. She developed frontotemporal dementia, which impacts about half of ALS patients, and took away her ability to control her facial expressions. And ultimately, ALS took my mom's life. She died at home in her own bed as she demanded. Because though she couldn't speak, she could give a thumbs down to the hospice nurse who asked her if she wanted a hospital bed instead.

According to the ALS Association, every 90 minutes, someone is diagnosed with ALS and someone dies of the disease. Because ALS is always fatal. And I don't wish that on anyone. Anyone. There are researchers who have been working on ways to slow down the progression of ALS and someday maybe even create a cure.

But the Department of Health and Human Services has proposed eliminating the government's centralized database that tracks ALS cases. It wants to cut funding for the researchers who could save someone else's mom's life. And RFK Jr., whose job it is to run this department, doesn't know anything about it. Or, I'd argue, doesn't care. I think Maryland Democratic Senator Angela Alsobrooks put it correctly last week. You've been unable to answer specific questions, sir. You are the wrong person for this job.

I'd only add one more thing. Robert F. Kennedy Jr., go fuck yourself. That's all for today. If you like the show, make sure you subscribe, leave a review, think of the man who paid more than $600 for a rump watch, and tell your friends to listen.

And if you're into reading and not just about how a Pennsylvania couple paid actually $640 for a Trump watch, but got a watch that said rump, like me, What A Day is also a nightly newsletter. Check it out and subscribe at crooked.com slash subscribe. I'm Jane Koston, and honestly, what's the difference?

Waterday is a production of Crooked Media. It's recorded and mixed by Desmond Taylor. Our associate producers are Raven Yamamoto and Emily Fore. Our producer is Michelle Alloy. We had production help today from Johanna Case, Joseph Dutra, Greg Walters, and Julia Clare. Our senior producer is Erica Morrison, and our executive producer is Adrienne Hill. Our theme music is by Colin Gillyard and Kashaka. Our production staff is proudly unionized with the Writers Guild of America East.

With a great selection of new Toyotas, everyone knows your summer starts here at your Toyota dealer. Even your pet parrot. Right? Your summer starts here. Well said. Dealer inventory may vary. See your participating Toyota dealer for details. Event ends June 2nd. Toyota, let's go places.

Welcome to Church's. What's up with those real deals? Boneless wings, tender wraps, or fries? An original chicken sandwich or one that's spicy? Mix and match, that's for you to decide. Church's Real Deals, made for real deals. Get any two, starting at $4. Only at Church's. Offer valid at participating locations.