Among the most contentious provisions in the One Big Beautiful Bill Act, which President Donald Trump signed into law on July 4, are its Medicaid work requirements. Starting in 2027, able-bodied, working-age Medicaid beneficiaries enrolled through Obamacare’s expansion of the program must spend at least 80 hours a month on either work, job training, community service, or some other qualifying activity to remain eligible. Georgia maintains Medicaid work requirements of its own.

It’s important to note that truly needy patients — including pregnant women, caregivers of dependent children, and the medically frail — are exempt from these requirements. But that hasn’t stopped Democrats from accusing Republicans of consigning the vulnerable to poor health.

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A new analysis by the Paragon Health Institute suggests otherwise. The study compared enrollees subject to Medicaid work requirements in Arkansas between June 2018 and April 2019 with a control group to measure how those requirements affected patient health.

The authors found no relative increase in preventable hospital admissions or emergency room visits among those subject to work requirements compared with those in the control group. That’s strong evidence that work requirements don’t endanger patient health.

Medicaid spending eclipsed $871 billion in 2023. That’s nearly 8% more than the program spent in 2022. The entitlement accounts for more than $1 of every $6 this country spends on healthcare. 

That kind of spending is not sustainable. It shouldn’t be controversial to ask those who should have the capacity to provide for themselves to do something in exchange for taxpayer-funded health coverage. Many are simply idle. 

As the American Enterprise Institute’s Kevin Corinth recently found, the typical nonworking, childless Medicaid beneficiary between the ages of 19 and 64 spends an average of over four hours a day watching television and playing video games. That’s roughly 125 hours a month — 50% more than the One Big Beautiful Bill Act asks them to work.

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This same group spends an average of just 22 minutes a day looking for work and 28 minutes caring for others.

Far too many Medicaid beneficiaries are taking advantage of a program intended for the truly destitute and incapacitated. Work requirements will help correct that injustice — without negatively affecting their health.

Sally C. Pipes is president, CEO, and Thomas W. Smith fellow in healthcare policy at the Pacific Research Institute. Her latest book is The World’s Medicine Chest: How America Achieved Pharmaceutical Supremacy — and How to Keep It (Encounter 2025). Follow her on X @sallypipes.