Georgia Republicans, under Gov. Brian Kemp, are conducting something of an experiment. Earlier this year, the state expanded eligibility for health insurance benefits under Medicaid — but it became the first in the nation to attach work requirements to that expansion. In doing so, Kemp is the latest conservative to predicate helping people in need on their showing that they’re worthy to receive the state’s assistance.
We’ve heard this tale again and again in attempts by Republicans and even some conservative Democrats to choke off access to public benefits by adding various kinds of work requirements. Some argue that creating hurdles for people to clear before getting help is a fiscal matter, preventing waste and fraud. Others present it as a moral imperative, keeping Americans from growing lazy on the government’s handouts. But the effect is always the same as we see in Georgia, completely hindering the program’s effectiveness and giving those who never wanted to provide public benefits at all one more reason to cut them entirely.
The effect is always the same as we see in Georgia, completely hindering the program’s effectiveness
The meager expansion that Kemp signed off on mandates that newly enrolled recipients prove they’ve spent 80 hours a month working, volunteering or studying. He first pitched the current set-up to the Trump-era Centers for Medicare & Medicaid Services as part of that administration’s efforts to retool Medicaid. In an October 2020 letter to the Georgia Department of Community Health, which oversees Medicare and Medicaid for the state, then-CMS Administrator Seema Verma cleared Georgia’s pilot program; she highlighted the state’s initial analysis, which predicted that the new requirements would still see 30,000 Georgians sign up in the first year.
After a change in presidential administration and several court battles, Georgia finally opened the expansion to the public in July. But as Politico reported this week, the reality hasn’t matched up with that prediction. Only 1,800 people have enrolled in the first four months, putting the state on track to miss the mark by about 25,000.
Both critics and supporters of the program stress that not enough has been done to spread the word about the expansion. But it shouldn’t come as a surprise that onerous red tape has made it more difficult for people to sign up. As The Atlantic’s Annie Lowry wrote in 2021, works requirements and other types of “means testing” lead to a “time tax” — “a levy of paperwork, aggravation and mental effort imposed on people in exchange for benefits that putatively exist to help them.”
There’s already plenty of evidence disproving the idea that adding work requirements to public benefits helps motivate people to get jobs. A similar system set up in Arkansas wound up seeing 18,000 people lose their coverage in just seven months. A 2019 study of the program found that there was no notable increase in employment in the state because of the policy. And with unemployment still hovering near historic lows, there’s no proof that there are people currently lounging around who will take low-paying jobs to gain health insurance.
That’s not the lesson that opponents of the Medicaid expansion, like the Foundation for Government Accountability, are taking from the low sign-up rates. “As so few able-bodied adults are willing to work, train or volunteer even part time to qualify for the Pathways program, it’s clear that a full expansion would discourage employment for those who can work and risk resources meant for the truly needy — low-income children and people with disabilities,” Jonathan Ingram, the foundation’s vice president of policy and research, told Politico. Despite work requirements’ consistent record of failure, the GOP keeps beating this dead horse. In this telling, these mythical freeloaders are stealing from children and disabled people. But let’s not forget that Republicans are barring those same “resources for the truly needy” in states around the country. Many GOP-led states — including Georgia — have refused the Medicaid expansion passed as part of the Affordable Care Act, aka Obamacare. Georgia Republicans agreed to the bare minimum of a Medicaid expansion, granting access for people earning up to the federal poverty line — about $14,500 for an individual or $30,000 for a family of four. The expansion under the ACA, by contrast, applies to adults with incomes up to 138% of the poverty line — or roughly $20,100 per year. Despite work requirements’ consistent record of failure, the GOP keeps beating this dead horse. MAGA Republicans in the House are pushing to add work requirements to Medicaid nationally, an effort that has so far been unsuccessful. But the GOP managed to use the debt ceiling negotiations this year to add similar requirements to access SNAP, formerly known as food stamps, and the Temporary Assistance for Needy Families program. These efforts to slash access and funding to federal programs, against all evidence, should inform how we view programs like Georgia’s. It’s the governmental equivalent of purposefully failing at a task in order to get out of having to do it. Why take on the political pain of coming out against helping the needy when you can turn a public health program into a pipeline for cheap labor for businesses? And if that fails, well, clearly the needy weren’t so needy after all, giving bad-faith actors all the justification they need to cut off access yet again.
Hayes Brown is a writer and editor for MS NOW. He focuses on politics and policymaking at the federal level, including Congress and the White House. 
