Reliable access to health care allows people to work. 

It’s ironic, then, that come 2027, approximately 90,000 Maine residents will become subject to federal work requirements to qualify for MaineCare, our state’s Medicaid program.

In order to be eligible for coverage, 80 hours of work or community service activities per month must be proved every six months. A narrow set of exemptions apply. 

Tucked into the Trump administration’s “big, beautiful bill,” this novel, cynical conditionality is likely to cause trouble for one third of that group in Maine, or 31,000 enrollees, according to the Maine Department of Health and Human Services (which expects to pay a non-trivial $8 million to implement the rule and $5.5 million annually on enforcement),

Many of us know this is coming, have heard about the rule and have some loose sense of the numbers. But not until we read a piece of reporting like the feature we published last week – “Work requirements would strip MaineCare from thousands. Who are they?” (Aug. 14) – do the real-world ramifications come to life.

After the bill passed, a New York Times report called the work requirement “new hurdle for poor Americans,” which it is. According to our reporting, “verification barriers, unreliable internet access and other challenges are expected to cause tens of thousands of Mainers to fall through the cracks and lose coverage in the first year of the new work rules.”

We’ve become all too familiar with the bootstraps, “grind culture” mindset that captivates MAGA Republicans and others, a belief in insisting on striving sharpened by a belief that millions of lazy Americans choose to leech from social welfare programs they see as providing “lifetime handouts.”

“Prove that you matter,” Dr. Mehmet Oz, the Trump administration’s Centers for Medicare and Medicaid Services administrator, said during an interview with Fox Business in June. “Do something that shows you have agency over your future.”

Our reporters spent time with Kelli Austin, a Waterville woman on Medicaid who is approaching the work requirement with considerable trepidation. Her response to that incurious Dr. Oz challenge was very simple: “I don’t know how many hours I’m going to work,” she said.

For Austin, working hours are contingent on a part-time job as a peer recovery coach in Winslow. She picks up seasonal work at L.L.Bean when it’s available – and, critically, when she’s physically up to it. Among other conditions, Austin has been diagnosed with “two autoimmune diseases, hereditary neuropathy, rheumatoid arthritis, fibromyalgia, bipolar disorder, anxiety, attention-deficit disorder and nerve pain.”

Access to health care allows her to work. This is the inconvenient bottom line that advocates for work requirements prefer to ignore and ignore at their peril, at our collective economic peril. What are often referred to as the “downstream economic effects” of a move like this are very troubling. Georgia and Arkansas don’t need this explained to them; both have imposed work requirements with mixed results. 

In Arkansas a few years back, Medicaid enrollees reported confusion and frustration. According to a 2019 New England Journal of Medicine analysis that took stock of the requirements’ first year, the work requirements were “associated with significant losses in health insurance coverage in the initial 6 months of the policy but no significant change in employment. Lack of awareness and confusion about the reporting requirements were common, which may explain why thousands of persons lost coverage even though more than 95% of the target population appeared to meet the requirements or qualify for an exemption.”

Also faced with low uptake and administrative challenges that have been enough to change the tune of Republican lawmakers responsible for it, Georgia moved to reduce its verification of work for an expensive and divisive Medicaid program, Pathways to Coverage, from monthly to yearly (the state is verifying annually; the enrollee, of course, still has to file paperwork monthly).

Budget cuts drive this headlong, economically illiterate push. The hard reality of what it is to be sick, to be well and to cobble together a living in the United States is not factored in.

Next June, the White House will publish the rules for state-by-state implementation. Until then, not enough can be said about the need for informed steps to right this flimsy vision’s stark wrongs. 

Look no further than the case of Kelli Austin. “Without Medicaid, what would I do?” she asked, before answering her own question. “I would be dead.”