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Medicaid’s “Able-Bodied” Adults

A blog entry posted by Erin Kissane on .

In building out our Medicaid explainer, we uncovered a lot of actual complexity and plenty of plainly inaccurate information about who’s enrolled in Medicaid — and what it means to take away their healthcare coverage. We’re not a debunking organization and we will not try to chase every incorrect statement coming out of the Trump administration, Congress, and the media. But we will point to solid analysis from people who are working from the closest thing we can find to ground truth.

We’ll start with the administration’s attempt to characterize millions of people at risk of losing Medicaid as healthy young men who just don’t want to work. It turns out that every part of this claim is false, and the truth is much more dire.

Who are these “able-bodied” non-working adults on Medicaid?

Census data analysis from the healthcare specialists at KFF offers a clear picture of the relationship between Medicaid and employment, which is that 92% of people enrolled in Medicaid either are working already or are out of work because they’re students, caregivers, or people with disabilities.

The Congressional Budget Office estimates that about five million people will be pushed out of Medicaid by the recent budget reconciliation bill’s work-reporting requirements. Republican politicians and high-profile media commentators are using this figure to claim that five million healthy young men on Medicaid are sitting around playing videogames, watching TV, and refusing to get jobs.

The folks at KFF Health News and the Poynter Institute’s Politifact Health Check have collected a lot of great quotes from top-notch healthcare policy analysts about the situation. Their breakdown is worth reading in full, but the upshot is: No, that is not what the Congressional Budget Office said.

In fact, that group of five million people who may lose their Medicaid coverage includes millions who should remain eligible — because they’re working already, attending school, experiencing serious health problems, have disabilities, or are caregivers for elderly or disabled family members. Many of these people who should be exempt from work requirements will lose Medicaid anyway. This is because, as we’ve seen in multiple experiments with work-reporting requirements in both “red” and “blue” states (PDF), proving to the government’s satisfaction that you’re doing all the things you’re supposed to do is very different from (and much harder than) just doing them. And there’s nothing at all in the CBO estimates about how many people are actually refusing to work or about how anyone spends their time.

So where do the “sitting around playing videogames” claims come from? They’re taken from an analysis by the right-wing American Enterprise Institute that classifies millions of adults on Medicaid who have disabilities or serious health problems as “able-bodied.” This allows officials and commentators to cast people subject to work-reporting requirements as lazy time-wasters. (The People’s Policy Project has a really strong breakdown of the problems.)

But expert analysis of census data covering the people work-reporting requirements are meant to target (that is, non-disabled, non-student, working-age Medicaid enrollees without child dependents) paints a very different picture:

On top of this, many people who are in fact not “able-bodied” are also at risk of losing coverage because it’s unclear whether states will exempt them from the new work-reporting requirements if they haven’t successfully navigated the long and very narrow path to approval for disability benefits through the Supplemental Security Income or Social Security Disability Insurance programs. (The approval process is expected to get even harder thanks to the administration’s cuts at the Social Security Administration.)

So how many people enrolled in Medicaid aren’t working because they choose not to work?

About 300,000 people, according to detailed analysis from health policy folks at Brookings, a nonpartisan think tank. (Analysis from the Urban Institute agrees with this estimate.) Being healthy, those 300,000 people don’t actually use much healthcare, so they cost Medicaid programs very little.

To exclude those 300,000 low-cost patients, Medicaid programs will now make more than 18 million people — many in poor health and very difficult circumstances — jump through paperwork hoops to repeatedly prove themselves eligible for coverage.

According to the CBO estimates we mentioned earlier, about 5 million of those people won’t be able to meet the reporting requirements. If only 300,000 of them aren’t working because they don’t want to, back-of-the-envelope math suggests that about 4.7 million people who should be eligible will lose coverage.

These millions of people won’t lose coverage because they’re not doing a required activity like working, attending school, looking for jobs, etc., but because they won’t know about the rules, won’t understand them, or won’t be able to regularly gather and submit the required proof. They’ll be people like Luke Seaborne, a Georgia man on Medicaid who publicly supported his state’s work-reporting requirements in video testimony and then lost his own coverage — twice — because of the program’s complex bureaucratic requirements.

But does Medicaid actually help us?

Yes. Research from the University of Chicago’s Becker Friedman Institute for Economics found that expanding Medicaid to cover more low-income adults reduced enrollees’ risk of mortality by an average of 21%. The expansions saved more than 27,000 lives between 2010 (when the Affordable Care Act passed) and 2022.

A research survey published in the journal Current Oncology also compiled evidence that Medicaid expansion was associated with more timely diagnoses, more effective treatment, and better survival rates for cancer patients, including children.

How many people are on Medicaid, anyway?

KFF published a really helpful post explaining why (and where) there are three very different numbers in use to describe how many people rely on Medicaid: 71 million, 83 million, and 69 million. All three have a basis in fact, but they use different data sources. Unbreaking follows the experts at KFF and uses the 83 million number; we think it provides the best picture of how many people depend on Medicaid for their healthcare and long-term care coverage.

Why do these numbers matter?

KFF’s polling suggests that most people who live in the US have either been enrolled in Medicaid or had a family member who was. Before the passage of the trillion-dollar Medicaid cuts this summer, a majority of people across the political spectrum approved of Medicaid and wanted its funding to be maintained or increased. Having failed to build support for the cuts before pushing them through, some GOP Congressional leaders and Trump administration figures are now trying to excuse them in ways that echo deceptive Reagan-era “welfare queen” cliches.

With the cuts already passed, why the push now to characterize them as punishments for lazy young men who are stealing Medicaid from worthier recipients? Most obviously, supporters of the Trump budget are doubling down in their efforts to shift public opinion because forcing through deeply unpopular legislation is not generally considered a wise strategy for winning votes. But also, the cuts aren’t set in stone and there’s still time to prevent some of them from taking place. Congress’s Republican majority made sure the bill’s most harmful blows won’t land until after the 2026 elections, hoping to avoid a battle with their constituents. If voters stay mad until the midterms, we may have opportunities to push back.

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