Let us dispel the myth that the Medicaid expansion only insures able-bodied people who don't want to work:
A conservative critique of the Affordable Care Act’s (ACA’s) expansion of Medicaid eligibility is that it helps adults who are “able-bodied” and may discourage them from working. For example, a policy summary released by House Republicans proposes that “Obamacare’s Medicaid expansion for able-bodied adults [should] be repealed in its current form” (emphasis added). Arkansas Governor Asa Hutchinson has declared that if people are not willing to work and are “able-bodied, they ought to be kicked off the system.” In fact, the great majority of adults covered by the Medicaid expansion are in ill health or are already working, in school, or looking for work.
This false understanding of Medicaid recipients and their health insurance options has already influenced policymaking at the state level. For example, Arizona plans to seek a Medicaid waiver to limit able-bodied adults to a maximum of five years lifetime coverage and impose work requirements during that period. Similar waiver proposals have been consistently rejected in the past because they are contrary to the statutory objectives of Medicaid, which has never imposed lifetime limits or work requirements. But there is a risk that such a waiver might be approved in today’s policy environment.
These policy ideas stem from a serious misunderstanding about Medicaid recipients and a flawed belief that employment effectively assures health insurance coverage. In reality, only a small share of the adults covered by Medicaid expansions are in good health but not working, in school, or looking for work. Moreover, the types of low-wage jobs available to Medicaid enrollees are unlikely to offer meaningful health insurance coverage.
Data from the 2015 National Health Interview Survey illustrate that most healthy Medicaid expansion beneficiaries are working or pursuing economic opportunities. Half (48 percent) of adults covered by the Medicaid expansion are permanently disabled, have serious physical or mental limitations—-caused by conditions like cancer, stroke, heart disease, cognitive or mental health disorders, arthritis, pregnancy, or diabetes—-or are in fair or poor health. Low-wage jobs are often physically demanding, precluding those with limitations from employment. Of the other half, who might be viewed as “able-bodied,” 62 percent are already working or in school and 12 percent are looking for work; only 25 percent are not currently working or in school. (More information about the analyses is at the end of this brief.)
Only 13 percent of adults covered by Medicaid’s expansion are able-bodied and not working, in school, or seeking work. Of that small group, three-quarters report they are not working in order to care for family members and the rest report other reasons, like being laid off. A much higher share of overall American adults are unemployed or not in the labor force (28 percent), according to 2015 Census data. Medicaid expansion enrollees are more likely to be working or looking for work than the general public, unless they are burdened by ill health or the needs of their families. Moreover, Medicaid expansions could make it easier for beneficiaries to find work, as reported in Ohio.