With budget negotiations between House Republicans and the Biden administration at a standstill, Medicaid work requirements are taking center stage. Policymakers of all stripes would do well to remember recent history, including the president himself, who supported work requirements as a senator during the Clinton entitlement reforms debate in the 1990s.

More importantly, policymakers must recognize that to promote health is to promote work. Research demonstrates that having a job improves health outcomes and is associated with longer life. Employment promotes physical activity, leading to better physical health . A workplace is a platform for social interaction, combating the epidemic of depression and boosting mental health . Unemployment, on the other hand, leads to social isolation and is associated with negative health consequences , such as high blood pressure, stroke, and heart disease.

The Biden administration wants state Medicaid programs to address the “social determinants of health,” or the non-medical factors that affect health. Yet, the administration has ignored or impeded work requirements for able-bodied adults, a policy that directly addresses non-medical factors affecting health. For example, the administration has rescinded many Centers for Medicare & Medicaid Services-approved state waivers permitting states to implement work requirements. They did so despite the fact that many waivers provided appropriately broad exemptions from work requirements. Utah’s, for example, exempted those who were pregnant or postpartum, care for children or for a disabled family member, or those who were undergoing substance abuse treatment.

Policymakers should remember that work requirements for social benefit programs aren’t new. This social contract between government and its citizens is a tradition dating back to Franklin Roosevelt’s Civilian Conservation Corps in 1933. Bill Clinton enacted work requirements for social programs through the 1996 Personal Responsibility and Work Opportunity Reconciliation Act, supported by then-Sen. Joe Biden.

Even today, progressive states such as California have realized the benefits of encouraging employment, with the Working Disabled Program , which allows individuals who otherwise wouldn’t be eligible for Medicaid to qualify and reduce their premiums by reporting work activities, even if it’s just “regularly picking up recyclable items to earn income.” Ironically, California state Sen. Ed Hernandez introduced a bill banning work requirements in Medicaid, describing them as “ misguided and mean-spirited .” Is working to improve the health and wealth of Californians mean-spirited?

When the Affordable Care Act (ACA) expanded Medicaid, the program grew beyond the destitute safety net population to include the able-bodied working poor. It is this very population that has the most to gain from being required to work, with estimates reporting that approximately 13% of Medicaid beneficiaries are able-bodied and not working. Of the latter, 30% reported being in “excellent health.” Moreover, many other existing social support programs have work requirements, such as the Temporary Assistance for Needy Families and the Supplemental Nutritional Assistance Program. Both require “employment-related activities,” such as job training or an active job search. Requirements are not rigorous, yet they are effective in increasing employment among beneficiaries. The Congressional Budget Office found that these work requirements have both increased employment and boosted earnings while having minimal effect on enrollment.

Medicaid work requirements could similarly require individuals to seek employment or contribute to community service, helping to invest in our nation’s infrastructure by improving parks, libraries, and roads and providing the unemployed a path to acquiring employable skills. Work can be further incentivized by adjusting eligibility so that working Medicaid beneficiaries don’t face a cliff where further income would disqualify them from benefits. Work requirements can supercharge our nation’s health by incentivizing employment, getting otherwise able-bodied individuals back into the labor pool, improving health outcomes, and driving increased economic growth.

Medicaid must remain a true safety net program, with Congress preserving society’s social contract by ensuring that the program is ready and able to help Americans who have suffered misfortune. Work requirements allow the Medicaid program to partner with its citizens to ensure that they achieve their best possible outcome: better health and earnings. By failing to do all we can do to promote work, we are not doing all we can do to promote health.

Anthony DiGiorgio, D.O., M.H.A., is an assistant professor of neurosurgical surgery at the University of California, San Francisco.