The Limit, Save, Grow Act of 2023 — House Republicans’ ransom conditions to lift the debt ceiling — would, among other things, create work requirements for people receiving Medicaid. The Congressional Budget Office estimates that this measure alone would strip 600,000 low-income Americans of their insurance.
The plan is certainly not going to take effect – President Biden has refused to pay a ransom to lift the debt ceiling, and even if he ends up renouncing this position, it would be unimaginable for him to accept such a draconian provision . But the fact that Republicans are voting for it sends a signal about what their party believes.
The purpose of the Limit, Save, Grow Act is to identify budget cuts that the entire Republican Party can agree on. They’ve ruled out cutting Medicare and Social Security because they see those programs as too popular to cut (or at least too popular to take the political pressure of voting to cut when they know the cuts will have no effect). They also ruled out cutting the defense because many Republicans oppose it. Several energy subsidies have been the subject of intra-Republican bargaining, on the grounds that they affect a handful of Republican districts.
But cutting Medicaid counts as a Republican unity position. Specifically, the Republican plan is to require people receiving Medicaid to prove they are working or taking steps to find a client or train to get one. In practice, this means they have to fill out a whole lot of complicated additional paperwork to continue getting their insurance.
Arkansas experimented with this policy under the Trump administration. The result was a failure, at least according to the stated policy objective of encouraging the unemployed to find employment. According to one study, it “did not increase employment over eighteen months of follow-up,” but it did cause people to lose their health insurance because they were unaware of job requirements or did not know how to find it. As a result, they delayed care, skipped medication, and had higher levels of medical debt.
CBO estimates, indeed, that of the 15 million Americans subject to the work obligation, some 1.5 million would fail. But he further estimates that 900,000 of those people would retain coverage because they reside in states that care enough about them to pay for their Medicaid; the remaining 600,000 reside in states sufficiently indifferent to their fate to leave them simply uninsured.
That tells you something about the Republican Party that this policy qualifies as one of the few tax measures to gain the unanimous approval of all members of its House. The idea of subjecting the poor to heavy red tape with the putative aim of getting them a job, knowing full well that the result will be that many of them will be uninsured, is seen as a great victory.
In fact, it tells you a lot of things. He tells you that the party’s “populist” turn remains a fraud, at least as far as the allocation of material resources is concerned. It tells you that Republicans remain the only major political party in the industrialized world that believes people don’t deserve access to basic health care as a right of citizenship.
Whether the House succeeds in passing his bill — and keeps up his hopes of using the debt ceiling as a high-stakes hostage crisis against Democratic presidents — the CBO’s conclusion certainly isn’t going to hurt his prospects. There are a lot of things that would get the Republicans in trouble, but learning that their plan would create disaster in the lives of more than half a million of the most disadvantaged Americans wouldn’t even hurt their prospects.