Republicans are considering cuts to Medicaid, the joint federal-state health plan that provides taxpayer-funded health coverage to 80 million adults and children. Many in the GOP would like to require able-bodied Medicaid beneficiaries to work in exchange for coverage. That’s a good idea.
The federal government and the states spent some $870 billion on Medicaid in 2023. Adding work requirements would cut waste and help preserve Medicaid for those who truly need it.
Medicaid enrollment has ballooned under Democrats. Congress created the entitlement nearly 60 years ago to cover low-income, vulnerable Americans. But President Barack Obama expanded Medicaid eligibility to able-bodied adults earning up to 138% of the poverty level — $44,367 today for a family of four. Forty states and Washington, D.C., have signed up for this expansion.
Medicaid enrollment exploded under the Obama administration. In June 2008, Medicaid had just 43.5 million enrollees. By 2016, that number had surged to 72.8 million. President Joe Biden created additional incentives during the pandemic for states to keep enrollment high. In March 2023, Medicaid had a record 94 million enrollees on the books.
Now, Republicans want to bring the program back in line with its original intent. Some are calling for enrollees aged 16 to 59 to work or volunteer at least 80 hours per month to qualify for Medicaid. Students, caregivers of young children, pregnant women, the disabled, and the homeless would be exempt.
Asking able-bodied people to work in exchange for public benefits is hardly a novel idea. Work requirements already exist for food stamps. But Democrats aren’t convinced. They argue that most Medicaid recipients already work.
A recent analysis from the American Enterprise Institute suggests otherwise. In December 2022, just 44% of healthy, working-age Medicaid recipients without children worked a minimum of 80 hours per month. By contrast, 72% percent of healthy, working-age adults without Medicaid worked at least an 80-hour month.
These data suggest that Medicaid disincentivizes work. Beneficiaries may not want to risk losing their health coverage by working too much or getting a higher-paying job and seeing their incomes advance beyond Medicaid’s eligibility threshold.
But that’s exactly the sort of thing we should be encouraging. Public policy should put people on the path to self-sufficiency, not trap them in a state of semipermanent dependence on the welfare state.
GOP MUST CUT MEDICARE AND MEDICAID TO MEET BUDGET TARGET: CONGRESSIONAL BUDGET OFFICE
Work requirements would also reduce federal spending by $120 billion over 10 years, according to the House Budget Committee.
Republicans can’t afford to get squeamish about Medicaid cuts. Work requirements are a good way to start restoring the program to its original mission.
Sally C. Pipes is president, CEO, and Thomas W. Smith fellow in healthcare policy at the Pacific Research Institute. Her latest book is The World’s Medicine Chest: How America Achieved Pharmaceutical Supremacy — and How to Keep It (Encounter 2025). Follow her on X @sallypipes.