Of all the provisions included in Republicans’ “big, beautiful” reconciliation legislation, Democrats hope to make the most politically out of the Medicaid reforms. As I have previously noted at The Federalist, the bill does not “cut” Medicaid, as that program will still grow by roughly $1 trillion in the coming decade.

Among the various Medicaid reform provisions, the largest amount of projected savings comes via work requirements on able-bodied adults participating in Obamacare’s Medicaid expansion. These provisions do not apply to vulnerable populations such as individuals with disabilities and pregnant women. Indeed, the new law intends to preserve and protect Medicaid for these populations, for whom the program was originally designed in the first place.

Despite the general public support for Medicaid work requirements, Democrats still attempt to characterize the provisions as unduly onerous. The facts indicate otherwise and demonstrate the reasonable nature of this new policy.

Most Medicaid Recipients Report No Earned Income

Democrat groups try to claim that most Medicaid recipients work at least part-time, making the new requirements an attempt to remove otherwise-qualified beneficiaries by tying them down with unnecessary paperwork. But these claims are premised upon survey data, which by definition relies upon 1) population sampling techniques and 2) beneficiaries’ own recall, both of which have the potential for significant errors.

A recent study by the Foundation for Government Accountability, which examined beneficiaries’ actual earnings history, shows a far different picture. Based on the individual earnings of almost 21 million Medicaid beneficiaries in 23 different states, nearly 2 out of 3 able-bodied adults on Medicaid (62 percent) reported no earned income, meaning they weren’t working.

This data provides further confirmation of a phenomenon I chronicled last year. In states that have not expanded Medicaid, individuals need to have income equal to the federal poverty level ($15,650 for an individual in 2025) to qualify for subsidized Exchange coverage. That means an individual working 30 hours per week at a job making $10 per hour, or working 20 hours per week at a job making $15 per hour, would qualify for Exchange subsidies — which in 2025 would give him a zero-premium (or, as Democrats would call it, “free”) benchmark plan.

The fact that states that have not expanded Medicaid face pressure to do so reinforces that able-bodied adults are not working. In these states, the earnings requirement to achieve income of at least 100 percent of poverty to qualify for Exchange subsidies functions as a de facto work requirement. The fact that so many individuals cannot meet this comparatively low earnings threshold indicates that much of the potential Medicaid population does not work.

Lack of Activity by Nonworkers

For those individuals who do not work, how do they spend their time? A recent analysis by an American Enterprise Institute scholar revealed results that did not seem altogether surprising:

For Medicaid recipients who do not report working, the most common activity after sleeping is watching television and playing video games. They spend 4.2 hours per day watching television and playing video games, or 125 hours during a 30-day month. … They spend on average 6.1 hours per day, or 184 hours per month, on all socializing, relaxing, and leisure activities (including television and video games). (Emphasis mine.)

Given that nonworkers on the Medicaid rolls spend more than 180 hours per month watching TV, playing video games, and otherwise relaxing, it seems entirely reasonable for the government to require such individuals to devote less than half of that time, or 80 hours per month, to working, volunteering, or otherwise engaging in productive activities with their time as a condition of receiving taxpayer-funded health coverage.

A Victory for Common Sense

For hard-working American families who cannot afford to spend six hours per day playing video games or “relaxing,” these new requirements seem like an eminently sensible proposition. Requiring work from those who are able to do so will help them transition from a life on the government rolls, building confidence and marketable economic skills that can stay with them for the rest of their lives. It may also help to alleviate some of the workforce shortages that businesses saw in the years immediately following Covid lockdowns.

The fact that Medicaid work requirements remain a partisan issue illustrates how Democrats have deliberately fostered a dependency culture via perpetual expansions of the welfare state. Reestablishing a culture of work via the reconciliation bill represents a hard-earned victory for common sense.