Republicans in the U.S. House of Representatives have passed legislation that would require about one-third of Medicaid enrollees to be employed or looking for work, which would be a radical shift in the safety net program’s mission and operations. Although the bill has little chance of becoming law, given Democrats’ control of both the Senate and White House, many health care policy experts have been quick to name work requirements’ many downsides — and one health insurance trade group denounced the proposal.
The work requirements proposal narrowly passed the House on April 26 in a party-line vote. It’s part of H.R. 2811, the Limit, Save, Grow Act of 2023, a bill that is Republicans’ latest offer in ongoing negotiations with congressional Democrats and the Biden administration over raising the federal debt limit, which is projected to reach the current limit in July. The work requirements proposal is one part of a broader package of austerity measures. In a notable break with past work requirements policies, including those of the Trump administration, the H.R. 2811 proposal would make work requirements a part of the Medicaid program in every state. The Trump administration’s Medicaid work requirements policy required states to implement such programs through Section 1115 waivers, which allow states to waive certain Medicaid rules in order to test “budget-neutral” policy approaches aimed at better serving Medicaid populations.