To work, care for, and support our families and communities, we need to be healthy. To be healthy, we need health coverage. Health insurance, in other words, should come before work.
This is why other wealthy countries guarantee access to health care, and health coverage is not typically tied to work.[i] The American health care system, however, developed around employer-sponsored health insurance. While receiving health coverage through your employer may work for some workers, some of the time, it leaves behind many people, including people who do gig work or are otherwise working part-time or between jobs, people who are older or disabled and unable to work, and people who are caring for loved ones or doing other unpaid labor. Problematically, it also leaves behind the children who live in all of these households.[ii] To fill these gaps, lawmakers created Medicare and Medicaid in the 1960s, the Children’s Health Insurance Program (CHIP) in the 1990s, and Affordable Care Act marketplaces in the 2010s. Medicaid is now the nation’s single largest health insurance program, providing health coverage for one in five people living in the United States and two in five children .
Today, however, lawmakers are considering rolling back this progress and making work a condition of coverage for certain adults who are insured by Medicaid. Work requirements in Medicaid and other programs that meet families’ basic needs are driven by the false assumption that people do not want to work and can be forced to work by threatening to take away assistance they rely on every day to meet their families’ needs. However, the existing research clearly refutes these assumptions:
- The majority of adults insured through Medicaid are already working and the vast majority of those who are not working are unable to because of their own caregiving responsibilities, illness or disability, or school attendance. Requiring people to report work hours or activities will not do anything to change these circumstances but rather creates roadblocks to health and economic stability for individuals and families who are already struggling to cover their basic needs.
- Imposing work reporting requirements on programs that meet families’ basic needs does not significantly increase employment or help people find or keep family-sustaining jobs. Instead, it takes away critical supports by setting unrealistic minimum work hours or creating unnavigable reporting requirements. In practice, work requirements create gaps in assistance and coverage that undermine health and well-being and make it more difficult for individuals and families to lead fulfilling and productive lives.
Now more than ever, it is important to remember that Medicaid was created to solve the problems created by linking health insurance to work in the first place. Instead of imposing ineffective work requirements that will drive up administrative costs and put millions of people at risk of losing their health coverage, we should be moving toward universal health coverage—so that we can all be healthy and thrive.
For more from CSSP on the problems with work requirements, in Medicaid and other programs that meet families’ basic needs, see:
The Racist Roots of Work Requirements
Ending Barriers to Support: Five Arguments Against Work Requirements
[i] Among OECD countries where private health insurance is most common, employers are playing a growing role in sponsoring that coverage, but public coverage and delivery systems serve the majority of people. See Colombo, Francesca and Nicole Tapay. “Private Health Insurance in OECD Countries: The Benefits and Cost for Individuals and Health Systems.” OECD Health Working Papers No. 15. Available at: https://www.oecd.org/content/dam/oecd/en/publications/reports/2004/01/private-health-insurance-in-oecd-countries_g17a1697/527211067757.pdf. See also “Private Health Insurance Spending.” OECD, March 2022. Available at: https://www.oecd.org/content/dam/oecd/en/publications/reports/2022/03/private-health-insurance-spending_936ad24d/4985356e-en.pdf.
[ii] Other problems with employer sponsored health insurance include job lock and the fragmentation of health care finance. See Dolan, Ed. “What’s Wrong with Employer Sponsored Health Insurance.” Niskanen Center, November 6, 2018. Available at: https://www.niskanencenter.org/whats-wrong-with-employer-sponsored-health-insurance/.
