Public attitudes about Medicaid work requirements

Since its inception in 1965, Medicaid has been a hot-button issue subject to fierce political debate. Created to protect the health and well-being of American families and to provide health care access to low-income individuals, the program currently covers one in five Americans.

The Trump administration has prioritized reforming the Medicaid program since taking office, pushing to add work requirements that mandate that all beneficiaries either be employed or looking for work to stay on Medicaid. Administration officials have argued that adding work requirements to Medicaid helps to prioritize scarce government resources, provides a way out of poverty for beneficiaries, and helps to counteract the disincentives inherent in public assistance programs.

Opponents of work requirements, however, argue that taking away medical coverage for those who are not working goes against the goal of alleviating poverty and improving health, while impeding Medicaid beneficiaries from potentially transitioning into stable work environments.

Critically, the debate over the benefits of work requirements has spilled out of the political arena and influenced the attitudes of the American public on the topic as well.

A recent study by Timothy Callaghan, PhD, assistant professor in the Department of Health Policy and Management at the Texas A&M University School of Public Health, and his co-authors examines these public attitudes and analyses public opinion about Medicaid and work requirements.

Their research, which has been published in the Journal of Health Politics, Policy and Law, shows that the general public is split close to even on the question of whether work requirements should be added to the Medicaid program.

“The even split in the general public reflects the even split of political leaders on the topic throughout the country, with conservatives generally in favor of adding work to Medicaid and liberals opposed to the reform,” Callaghan said.

According to Callaghan and his co-authors, the debate over work requirements for Medicaid is not new, and is just the latest episode in the effort to define the parameters of the complex insurance program. The researchers say that debates over program eligibility have gone on for decades, and there is no clear-cut answer on if it will be completely resolved in the near future.

In the study, the researchers took a deeper dive into the subject by looking at the factors that determined whether Americans support or oppose work requirements. By relying on a national survey of American adults, the authors were able to determine that individuals who support work requirements in Medicaid are more likely to be conservative, to see Medicaid as a short-term program, and to hold higher levels of racial resentment.

The research team also worked to investigate one of the most important complexities of work requirements—whether some Americans should be exempt from the expectation of work to receive Medicaid.

According to the researchers’ findings, groups that have historically been framed as deserving of social welfare benefits, such as those with disabilities and those over the age of 65, see high levels of support to be exempt from the need to work to receive Medicaid. On the other hand, groups that have historically not been seen as deserving of social welfare benefits, like people with drug addiction, are not seen as deserving of work requirement exemptions.

Finally, the authors explored whether the government should provide support to the public to make the transition to the workforce easier if work requirements are going to be mandatory. There, Callaghan noted that “the general public shows high levels of support for policies that would make the transition to work easier” and that “politicians supporting work requirements would see broad support from the public for childcare assistance, transportation assistance, and other supports that make entering the workforce easier.”

Callaghan’s co-authors include Simon F. Haeder, assistant professor of public policy at The Pennsylvania State University, and Steven Sylvester, assistant professor from the Department of History and Political Science at Utah Valley University.