The signing up of millions of additional Americans for taxpayer-funded health care coverage like Medicaid and the Affordable Care Act's marketplace during the Biden administration was lauded by Democrats as a success. The $880 billion Medicaid program is financed mostly by federal taxpayers, who pick up as much as 80% of the tab in some states.
To whittle down the budget, the GOP-controlled Congress is eyeing work requirements for Medicaid. It's also considering paying a shrunken, fixed rate to states. All told, over the next decade, Republican lawmakers could try to siphon billions of dollars from the nearly-free health care coverage offered to the poorest Americans.
Weeks before Congress began debating those changes, Republican governors in Arkansas, Ohio and South Dakota were making moves to implement Medicaid work rules of their own.
And other cuts could be on the way. Already on Friday, the Republican administration announced it would shrink the Affordable Care Act's navigator program annual budget by 90% to $10 million. Navigators are stationed throughout the country to help people enrolled in ACA and Medicaid coverage and have helped boost enrollment in health care programs.
What Republicans are proposing
Speaker Mike Johnson of Louisiana has floated the idea of tying work to Medicaid.
“It’s common sense,” Johnson said. “Little things like that make a big difference not only in the budgeting process but in the morale of the people. You know, work is good for you. You find dignity in work.”
Republicans have suggested a work requirement similar to the conditions for the Supplemental Nutrition Assistance Program, commonly called food stamps. Those ages 16 to 59 must work or volunteer at least 80 hours a week if they are not in school, caring for a child under age 6, disabled, pregnant or homeless. On average, a SNAP enrollee's monthly household income is $852, and the enrollee typically receives $239 in benefits.
During a GOP House retreat last month at Trump's golf resort in Doral, Florida, Republicans said the requirement could motivate people to find employment — maybe even a job that comes with health insurance.
Rep. Darrell Issa, R-Calif., said the spending cuts should not be “on the back of the poor and needy" but instead target those who shouldn't be getting the benefit.
“Why should somebody literally sit on the beach and surf, buy their sandwiches from the food truck with their food stamps and then pick up low-cost housing and so on, while writing a book," Issa said, noting that he was describing a constituent from more than a decade ago.
