The Limit, Save, Grow Act of 2023 — the House Republicans’ ransom terms for lifting the debt ceiling — would, among other things, create work requirements for people receiving Medicaid. The Congressional Budget Office estimates that this measure alone would throw 600,000 low-income Americans off their insurance.
The plan is almost certainly not going to take effect — President Biden has refused to pay any ransom to lift the debt ceiling, and even if he winds up backing down from that stance, it would be unimaginable for him to accept such a draconian provision. But the fact that Republicans are voting for this does send a signal about what their party believes.
The purpose of the Limit, Save, Grow Act is to identify budget cuts that the entire Republican Party can agree on. They have ruled out cutting Medicare and Social Security because they see those programs as too popular to cut (or at least too popular to take the political heat of voting to cut when they know the cuts won’t take effect). They have likewise ruled out cutting defense because many Republicans oppose it. Several energy subsidies have been the subject of intra-Republican haggling, on the grounds that they matter to a handful of Republican districts.
But cutting Medicaid counts as a position of Republican unity. Specifically, the Republican plan is to require people receiving Medicaid to prove they are working or taking steps toward finding a job or training for one. In practice, this means they must fill out a bunch of additional complicated paperwork to keep getting their insurance.
Arkansas experimented with this policy under the Trump administration. The result was a failure, at least by the policy’s stated goal of encouraging unemployed people to get jobs. It “did not increase employment over eighteen months of follow-up,” a study found, but it did cause people to lose their health insurance, because they weren’t aware of the work requirements or didn’t know how to navigate them. As a result, they delayed care, skipped medication, and had higher levels of medical debt.
The CBO estimates, in fact, that of the 15 million Americans subject to the work requirement, some 1.5 million would fail. But it further estimates that 900,000 of those people would keep their coverage because they reside in states that care enough about them to shell out for their Medicaid; the remaining 600,000 reside in states sufficiently indifferent to their fate to let them simply go uninsured.
It tells you something about the Republican Party that this policy qualifies as one of the few fiscal measures to command unanimous approval across its House membership. The idea of subjecting poor people to onerous paperwork requirements in a putative effort to make them get jobs, with the full knowledge the result will be that many of them will go uninsured, qualifies as a big win.
In fact, it tells you many things. It tells you that the party’s “populist” turn remains a fraud, at least as far as the allocation of material resources is concerned. It tells you that Republicans remain the only major political party in the industrialized world that believes people don’t deserve access to basic health care as a right of citizenship.
Whether the House succeeds in passing its bill — and keeps alive its hope of using the debt ceiling as a high-stakes hostage crisis against Democratic presidents — the CBO’s finding is almost certainly not going to hurt its prospects. There are many things that would cause problems for the Republicans, but learning their plan would create a life disaster for more than half a million of the most underprivileged Americans will not make even a dent in their prospects.
