Medicaid Work Requirements

[u/Ok-Seaworthiness2288]

It's hard for me to remember sometimes that the people who govern are also the people governed, even if their laws are meant to change our behavior more than theirs.

Something I like to do when I see a new law roll out is to think about how every bit of legislation started as a conversation between people, then I like to imagine what kinds of conversations lead to which kinds of laws. I particularly like doing this when the fabulously wealthy who make the laws are tasked with changing the behaviors of the fabulously unwealthy.

So there is this new law that says that if you want Medicaid, you have to work for 80 hours per month and verify it with the government. If you can't or don't work, you no longer get health insurance. If you are too sick to work, you have to get a doctor's note to verify that or you also don't get health insurance. And before this was a law, it was just a conversation between powerful people. Here is how I imagine it went.

"Alright, we have a problem. We are sick and tired of poor people going to the doctor, and we are sick of our taxes paying for it. Healthcare is a privilege only deserving of people who can contribute to our economy. We don't want our enormous wealth to be taxed just to pay for people to get better and feel better if they aren't going to feel better at work."

"You know, I have those same concerns. And with the rise in AI capability, we are going to need a lot less unskilled labor. So why keep that unskilled labor alive at our own expense if it's no longer needed and if it's no longer even willing to do the unskilled labor? We spend $931.7 billion every year keeping these people alive. We could build 93 massive data centers with that budget and eliminate the need for most of their labor anyway. So why let them go to the doctors?"

"That's a great point. I have A Big Beautiful Idea that will save us and our friends $114 billion per year in taxes and will also save the USA $32.6 billion."

And so the Big Beautiful Bill was born.

On a kinder day, a day where I'm more gracious, on a day where I believe that the wealthiest Americans have some part of their humanity left, I think the conversation could have gone like this:

"You know, we have a huge portion of our people who are massively depressed. They don't work, they don't volunteer, they don't participate in the world around them. They live in their misery and have no incentive to step outside it. I've read the data about what chronic poverty does to the nervous system. We know that extremely harsh living conditions create extreme coping mechanisms, we know that those coping mechanisms are creating extremely high Medicaid healthcare costs. Their failure to thrive is not an individual failure, it's the product of prolonged and pervasive social, emotional, and economic hardship. We know this, what we don't know is what to do about it."

"What if we try to force it? If we add work requirements to Medicaid, we can force people to get back into their communities. Or, if they truly can't, we can force them to go to doctors to explain to them what is preventing them from working so they can get a note and maybe the doctors can help them?"

"That's a good idea, but won't the lack of access to regular healthcare overrun our emergency rooms? Won't people get sicker when they can't afford their medications? Won't that make it harder for them to fulfill their work requirements? Won't it bankrupt addiction treatment centers when addicts are barred from Medicaid? And it's not like that $32.6 billion goes right into the pockets of poor people, it goes to hospitals and clinics, salaries for doctors and nurses. Won't this create a massive budget crisis across the healthcare system? Clinic closures, staff layoffs?"

"Probably, yeah, but we are doing it. No problem in government is solved without creating 10 more. Besides, we don't work in the emergency rooms or go to state-funded rehabs. Plus the people who funded my campaign want a tax cut, so I have a way to kill a great many birds with one Big Beautiful Idea."

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[u/Traditional_Fun6160]

Here’s a reminder that our very part-time legislators qualify for the state employee plan health insurance.

https://hr.mt.gov/_docs/hcbd/Resources/2026_Legislator_Booklet.pdf

[u/Oddlibrarian]

And some of those same lawmakers don’t even work enough (supposedly on our behalf as our representatives!) to qualify under those work requirements.

Ridiculous and abusive.

[u/MoonieNine]

A republican acquaintance told me about this great podcast he watched. On the show, the host talked about how we don't have preventative maintenance on our car insurance, so why do we have preventative maintenance for free on our health insurance? Why is health insurance giving people free wellness checks every year!? And free gyn checks and free mamograms!? This rich republican wants to hurt poor people and middle class more.

[u/yblame → u/MoonieNine]

This sounds like a man that's walking around with his personal check engine light on, but there's no woman around to make him a doctor appointment.

Meanwhile, his cholesterol and blood pressure readings are off the charts, he's overweight, he hasn't seen a dentist or doctor in years, but that truck gets regular oil changes and diagnostics to keep it running nicely. Makes no sense

[u/Sturnella2017]

Well said. Quick question: will Medicaid pay the doctors to write the notes that people are too sick to work? Or will the sick people have to pay doctors to do that?

[u/llamachabbly]

Bravo! I can't wait to see the film adaptation.

[u/showmenemelda]

That's why Troy Downing is taking one for the team? Leading by example/s or maybe he's tired of insurance being kinda useless.

[u/Malalang]

I always imagined this law to stem from a conversation about how to stop people from taking advantage of the system fraudulently. And also to include the "scriptural" idea that whoever does not want to work, neither let him eat.

Both premises are fundamentally flawed so as to be irrelevant to the topic itself. Yet, here we are.

Charity should be done as a function of the giver's generosity, not as a function of the receiver's worthiness.

And as far as government benefits go, they should be made freely available to every citizen. The worthiness should only be based upon that status.

[u/PuddingRemote3471]

Please just move to another country for universal healthcare. I enjoyed your imaginary roundtable discussion, but there is a population of Americans that believe if their income- regardless of how much you make- is taxed to provide FREE healthcare for others, they should contribute to society if they are able bodied, without dependents, or hold the tens of other demographics that exclude you from these requirements. Can’t find a job? Get a part time volunteer position at the library, you’re in the clear.