Association for Public Policy Analysis & Management

Since taking office, the Trump Administration has taken a slew of actions to transform the American health care system and the social safety net. One of the major efforts in this vein have been the implementation of work requirements for Medicaid beneficiaries (Musumeci, Garfield, and Rudowitz 2018, Haeder 2019b). Not surprisingly, the Trump Administration has found willing partners in red states across the nation including, perhaps most prominently, Kentucky (Gangopadhyaya and Kenney 2018) and Arkansas (Gangopadhyaya et al. 2018).

Work requirements have been touted by proponents for a variety of reasons including encouraging a “culture of work,” prioritizing scarce government resources, providing a way out of poverty for beneficiaries, and undoing the disincentives inherent in public assistance programs (Feulner 2010, Mead 1989). Opponents, on the other hand, have countered that taking away medical coverage runs contrary to the goal alleviating poverty and transitioning Medicaid beneficiaries into stable work environments (Hahn et al. 2017). The partisan battle over their implementation has been fierce, with ongoing fights in state legislatures, governors’ mansions, and courts across the country (Kaiser Family Foundation 2019).

How do Americans feel about these Republican efforts to fundamentally transform the shape of Medicaid in the United States? Using a large, nationally representative survey, we analyze the predictors of support and opposition to Medicaid work requirements. Critically, we also go a step further, working to disentangle the very concept of work requirements beyond the neat black and white division of opposition or support. By analyzing how Americans feel about who should be exempt from work requirements, which activities should count as compliance with work requirements, and whether beneficiaries should be given additional assistance in their transitions into the workforce, we provide a more complete picture of the complexities of public attitudes on this emerging policy topic.

Not surprisingly, breaking open the black box of work requirements provides a much more nuanced picture of American attitudes towards their implementation. While public opinion on whether work should be mandatory to keep Medicaid benefits is split, the public does tilt towards supporting their implementation. Levels of support are particularly high among the elderly, individuals who think Medicaid should be a short-term benefit, and those with high levels of racial resentment. That said, when digging into the specifics of policy implementation, we find that Americans also appear to be much less punitive than the Trump administration. We find that large segments of the American public believe that groups like the elderly, certain caregiver groups, and full time students should be exempt from work requirements. Furthermore, we find considerable support for efforts to make finding work more feasible including transportation assistance, childcare assistance, and job training. In short, our analysis works to show the complexity of public attitudes on work requirements and the shades of gray therein.