NC Budget and Tax Center

Work requirements for access to healthcare ignore a simple truth about modern employment

Proposals to require people to report on work hours in order to access Medicaid (something that’s being considered this session at the North Carolina General Assembly both for exiting program participants and as a part of GOP proposals to close the coverage gap) fly in the face of some very basic labor market realities of the 21st Century.

As we noted in our recent report, research has consistently showed that the vast majority of those receiving Medicaid who can work are working. Those who have jobs are often working in low-wage, part-time jobs with unpredictable schedules that would make it difficult to report work hours in compliance with requirements and keep their health care.

A new report released by the Urban Institute this week provides additional findings using newly available survey data about the unique challenges facing workers and their risk of transitioning in and out of compliance with work requirements week to week for reasons beyond their control.

The researchers find:

“Our survey indicates that most nondisabled adults whose families participated in safety net programs in the past year were not on the sidelines but in the game, with nearly three in five working at the time of the survey, including about half working for an employer. However, work schedules for these adults are often unstable and unpredictable:

  • One in five works a rotating, split, or irregular shift.
  • Over half report fluctuations in weekly work schedules of 10 hours or more during the past month.
  • More than a third (39.1 percent) usually know their schedule one week or less in advance.
  • More than half (56.0 percent) have little to no input on when their workdays begin and end.”

The reality of unpredictable work schedules and hours and the very nature of work arrangements in today’s labor market make it impossible to design work requirements to help people stay employed and healthy.

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