Commentary, Legislature, NC Budget and Tax Center

GOP Medicaid bill takes a massive step in the wrong direction

Rep. Donny Lambeth, R-Forsyth, presenting the GOP’s Medicaid bill Tuesday.

Yesterday, legislators filed a new version of Medicaid expansion, House Bill 655, titled “NC Health Care for Working Families.” This bill imposes even harsher work compliance provisions on low-income and poor North Carolinians than previous versions.

Specifically, the bill follows the work reporting requirements seen in the Supplemental Nutritional Assistance Program (SNAP, formally known as food stamps). This raises a serious concern, considering that extensive research has demonstrated just how broken the SNAP program’s work provisions are.

A new report from the nonprofit ideas42 points out that not only do work requirements not help people to find jobs, the provisions seen in the SNAP program have the exact opposite effect. The report finds that:

  • The burdensome compliance of requirements dramatically increases the cost of obtaining assistance. Under SNAP rules, people are required to prove that they worked 20 hours a week. Lost paperwork, missed notices, and clerical errors have resulted in a significant number of people losing benefits, despite the fact that they’ve actually fulfilled the requirements. Additionally, many low-wage workers lack access to predictable schedules, paid leave, and other basic protections. This means that, regardless of a worker’s best efforts to comply, they may easily fall short due to circumstances completely out of their control.
  • Rigid work requirements fail to recognize that people living in poverty know best how to prioritize their time. People living in poverty face tremendous everyday pressures of deciding how to best use their time in order to fulfill their obligations and to make ends meet. The rigid 20-hour work requirement does not reflect the reality that a disproportionate number of low-wage workers are employed in seasonal industries with unpredictable hours, or that they are more likely to take time to care for sick or aging family members. Rather than attempting to legislate the schedules of North Carolinians living in poverty, policy makers should provide them with the tools to make decisions and choices to help lift them out of poverty.
  • These policies rely on and reinforce harmful and misguided beliefs about people living in poverty. Proponents of work requirements believe that these provisions will force people uninterested in work to find jobs. This presumption that this belief is built on could not be further from the truth. The U.S. Census Bureau found that less than 0.3 percent of SNAP recipients aged 18-49 reported that they are not working because they are not interested. Behavioral research has found that people living in poverty actually make better and more rational choices in regards to money than people with high incomes. This is because they have to. When living in poverty, there is very little wiggle room for wasteful or poor choices.

Rep. Donny Lambeth, R-Forsyth, states that the work requirements are a political necessity, arguing: “There are things we as legislators have to do in order to get things done.” This thought, however, does not reflect the emerging national conversation on work reporting requirements in our safety net programs.

Last year, proposals in Congress to make SNAP’s work requirements even more restrictive met opposition from both Republicans and Democrats. In a show of bipartisanship, legislators decided that more work requirements were not a good idea, and that making sure that struggling people receive the help they need was a higher priority.

Just last month, a federal judge ruled that similar Medicaid work requirements in Arkansas and Kentucky were illegal and that they undercut the entire objective of the Medicaid program to provide “medical coverage to the needy.” Research shows that when people have access to critical supports like food and healthcare, they are more likely to find gainful and steady employment.

Work requirements are an ill-informed attempt to legislate behavior and do not reflect the realities of people living in poverty. In fact, the science shows that they effectively take away the ability of people to make good, rational decisions. If our legislators are truly in the business of helping to improve the lives of North Carolinians, they will listen to the research and evidence and reject these harmful provisions.

Brian Kennedy II is a Public Policy Analyst for the Budget & Tax Center at the N.C. Justice Center.

One Comment


  1. […] For more information on why a work requirement for Medicaid recipients is bad policy, see:  http://pulse.ncpolicywatch.org/2019/04/10/gop-medicaid-bill-takes-a-massive-step-in-the-wrong-direct….  The Governor has included a more reasonable proposal for expanding Medicaid in his budget, but […]

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