On CNN, commentator Scott Jennings put a face on the case for Medicaid work requirements: "There are like almost 5 million able-bodied people on Medicaid who simply choose not to work. They spend six hours a day socializing and watching television." [1] It is a vivid picture, built to make cutting the program feel like common sense. The number under it does not say what he says it says, and the people in it are mostly not who he describes.
Where the '5 million' actually comes from
The figure is not a census of loafers. It traces to the Congressional Budget Office's estimate of how many people would lose coverage under work requirements, which is a projection of harm done, not a count of people declining to work. PolitiFact rated the claim False and went looking for any data supporting the idea that millions choose idleness. The closest figure, from the Urban Institute, is that about 2 percent of non-working Medicaid enrollees without dependents say they are simply not interested in working. [1] Two percent is not five million.
What Medicaid adults are actually doing
The bulk of the program's working-age adults are already in a job. KFF's analysis finds that 92 percent of working-age Medicaid adults are either working full or part-time, at 64 percent, or not working for a reason the requirements themselves would exempt: caregiving at 12 percent, illness or disability at 10 percent, and school at 7 percent. [2]
Data
| Working (full or part-time) | 64% |
|---|---|
| Not working: caregiving | 12% |
| Not working: illness or disability | 10% |
| Not working: in school | 7% |
A second KFF study, built on a different data source, lands in the same place: 53 percent of adults subject to the requirements had already worked at least 80 hours in the month examined, and nearly eight in ten either cleared that bar or had a reason that would likely qualify them for an exemption. [3] The population the rule is aimed at is, overwhelmingly, already meeting it.
Arkansas already ran this experiment
The country does not have to guess what work requirements do, because Arkansas tried them in 2018. More than 18,000 people lost their coverage, roughly one in four of those subject to the rule, almost entirely because they failed to navigate the monthly paperwork of reporting hours or documenting an exemption. [2] Employment did not rise. The policy did not move people into jobs they were refusing; it knocked eligible people off coverage they qualified for.
THE BOTTOM LINE
- "Almost 5 million able-bodied people choose not to work": False [1]
- 92 percent of working-age Medicaid adults already work or cannot, due to caregiving, illness, or school [2]
- Arkansas tried this in 2018: 18,000 lost coverage to paperwork, with no rise in employment [2]
The honest version of this debate is narrow. A sliver of enrollees could work and do not, and reasonable people can argue about them. The line that sells the policy, that five million Americans are choosing the couch over a job, is not in the data. What the data show is a paperwork filter that removes working people, caregivers, and the sick from their health coverage and calls it accountability.
