By: The Editorial Board – wsj.com – April 14, 2025

Six in 10 able-bodied adults on the healthcare program have no earned income.

Exhibit A is Medicaid, the fast-growing entitlement that now spends more than $850 billion a year while delivering subpar healthcare for the poor. The left and the press are trying to intimidate the GOP from addressing the program’s failures, and President Trump is already having doubts. But Republicans can win the Medicaid argument if they understand how the program has gone wrong, and make their case in the moral terms it deserves.

New research and polling on Medicaid work requirements help to clarify the stakes. More than six in 10 able-bodied adults on Medicaid report no earned income, according to a report from the Foundation for Government Accountability (FGA), a think tank. Voters tend to think of Medicaid as a safety net for low-income pregnant women and disabled Americans. But Barack Obama’s Affordable Care Act expanded the program into a permanent entitlement for childless men in prime working age.

Democrats claim those on Medicaid are working. You’ll hear statistics like this one from the Kaiser Family Foundation: 92% of able-bodied Medicaid adults under age 65 worked full or part-time, or were indisposed for a good reason such as caring for a relative or attending school.

But that figure is derived from government survey data, which are self-reported and rely on sample sizes as small as a few dozen. FGA, by contrast, obtained administrative records from state Medicaid agencies in 23 states, a far more complete picture of earnings for nearly 21 million able-bodied adults on Medicaid. It found that millions are declining to work at all, which is damaging to the country economically and culturally.

Democrats invariably paint this as ordering Americans back to indentured servitude. But the GOP’s proposed Medicaid work requirements in 2023 were extremely modest—20 hours a week, which could include training for a job or volunteering, say, at the local library.

Republicans offered exceptions for nearly anyone with a plausible reason. Pregnant, have children, or caring for an incapacitated relative? You’re exempt. Got a doctor’s note attesting that you’re unfit to work? Exempt. Ditto for anyone enrolled in school or getting help for alcohol or drug abuse.

Detractors of this eminently reasonable policy cite a 2020 study in Arkansas, which found work requirements didn’t increase employment. That study is a telephone survey and included enrollees who likely weren’t even subject to the work requirement, among many other shortcomings.

FGA’s more robust state data found 14,000 enrollees departed Arkansas’s program because their income increased—which should be good news. Medicaid is lousy insurance that doctors often don’t accept because of its low reimbursement rates. It should be a temporary last resort, and the GOP aim should be to move as many people as possible off the Medicaid rolls and onto employer options.

Some Republicans fear work requirements would alienate male MAGA voters, but that whiffs the politics. Some 62% of voters supported Medicaid work requirements in a recent Kaiser Family Foundation poll. That included 47% of Democrats, 60% of independents, and 82% of Republicans.

In other words, House Speaker Mike Johnson was on firm ground when he told a reporter recently that Medicaid isn’t “for 29-year-old males sitting on their couches playing video games” and that “we’re going to find those guys, and we’re going to send them back to work.”

Work as a condition for benefits is an American economic and cultural norm. If more healthy men get back into the workforce, and ultimately off Medicaid, the program will be able to focus on the poor for whom it was originally intended.

But “savings” aren’t the main reason to impose a work requirement. Too many Americans are checking out of work and civic life. Voters will reward a party with the conviction to do something about it—and the wit to fight back against Democratic distortions.

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Source: The Moral Case for Reforming Medicaid – WSJ