When I was a foster parent, I became very familiar with the concept of the “time tax.”
The children we cared for all qualified automatically for Medicaid, without which we, and probably most foster families, could never have been able to afford their care. But actually securing that care took much more time than finding care for our biological children, who were all covered by our private health insurance.
Getting a necessary procedure approved might take many calls and forms. Finding a provider who would see our child could take extra time and effort. And even when the needs were routine and providers who accepted Medicaid were already in place, the wait times might end up meaning that a whole afternoon would be spent in getting an appropriate diagnosis and prescriptions. One doctor even fit us in during her lunch break, which was itself delayed by the morning press of her scheduled patients. I don’t know what would have happened if I hadn’t had flexible work and the skills to make the system work for these children.
As a result, I have a personal perspective on the so-called “work requirement” for Medicaid that is part of the “big, beautiful bill” approved by the U.S. House and being taken up now by the Senate.
The bill will cut some $716 billion from Medicaid over 10 years (according to the Congressional Budget Office’s analysis of an earlier, less punitive version), primarily by pushing an estimated 8 million people off of the program entirely. Several million more are projected to lose insurance due to cuts to the Affordable Care Act.
Studies of Medicaid recipients, however, don’t find anywhere near 8 million people receiving benefits without working or qualifying for a legitimate exemption. The spending cuts, and losses in coverage, depend on raising the “time tax” paid by Medicaid recipients to the point where many will lose coverage they would normally qualify for.
The idea is simple: If people have to do enough paperwork proving that they qualify, and if state-istered Medicaid systems have to keep up with that paperwork, people will make mistakes and lose their Medicaid. They’ll miss a renewal notice, or file the wrong documents, or mis a deadline. And even if they do everything right, an overburdened state can delay the renewal process long enough that they lose coverage anyway.
When Arkansas was allowed to experiment with a work requirement, the state required recipients, many of whom did not have reliable internet access or computer skills, to create online s connected to reference numbers sent by mail to record their work hours. The state website was unavailable between 9 p.m. and 7 a.m. every day – the hours people who work or attend school are most likely to be free to pay the time tax.
According to research by the Kaiser Family Foundation, one person working as a software engineer lost coverage because the website wasn’t working and the phone system was unable to deal with the volume of requests for help.
Before Arkansas’ policy was overturned in federal court, some 18,000 people lost coverage, but there was no statistically meaningful increase in employment. The Congressional Budget Office’s own analysis backs this up: Work requirements for Medicaid don’t affect employment. The effect of work requirements is instead to cut Medicaid by imposing an increased time tax and seeing who can pay it.
As a Christian, and a pastor responsible for teaching the essential truths of our faith to a community, I consider it morally unacceptable and spiritually dangerous for a society to subject its poorest to these added burdens. It only makes things worse that these Medicaid cuts, along with $300 billion in cuts to nutrition assistance to families, will primarily be used to offset the cost of lowering taxes on the wealthiest Americans.
I understand the appeal of making it hard for people to “game” the system. But in a world where no system is perfect — where people sometimes check social media while they’re working, where very few tax returns get audited for accuracy and where, as every daily Dallas commute bears witness, not every person breaking the speed limit gets stopped — it seems that Medicaid is pretty good at making sure only eligible people get benefits.
This is not the view of a liberal fringe. Medicaid is broadly popular. Sen. Josh Hawley, R-Mo., has called attempts to cut Medicaid “morally wrong and politically suicidal.” Cutting the program in the guise of a work requirement may help the political calculations, but it leaves the moral reality unchanged.
Forcing people who need care to jump through hoops that will inevitably stop many of them is demeaning. I know, because I’ve done the jumping. It is unworthy of a society as good as ours aspires to be. Our senators have the opportunity and the responsibility to stop it.
Benjamin J. Dueholm is pastor of Christ Lutheran Church in University Park.