Call for Medicaid work requirements is greeted by a chorus of boos
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What Archambault does not acknowledge is that Medicaid serves the working poor, which includes low-wage workers who are working multiple part-time jobs that don't provide coverage or positions that fall just below the threshold that would qualify them for coverage by their employer (an all-too-common practice by companies to avoid providing benefits).
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Moreover, some family members who are caregivers might not be able to meet the work requirement. In a June 2 op-ed,
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Finally, this hyperfocus on which low-income people deserve access to subsidized medical care distracts from what should be the primary focus: that our federal leaders are promising 'savings' on the cost of benefits in order to advance massive tax cuts that will benefit the wealthy and increase the national debt.
Rosemarie Buxton
Haverhill
With health care costs skyrocketing, reform is needed — but not this kind
My Pioneer Institute colleague, Josh Archambault, is correct that we do need Medicaid reform, but the solutions he offers, an old trope of work-or-volunteer remedies that recall the 'welfare queen' stereotype of 40 years ago, will
As Archambault states, the original idea behind national Medicaid was to provide health insurance to seniors and people who are blind or have other disabilities. Over time, however, rapidly escalating health care costs strained the limits of employer-sponsored health insurance, and by 1995 the
Since that time, Massachusetts has chosen policies to expand health insurance coverage. Eligibility for Medicaid, known here as MassHealth, has grown to include those who are not only below poverty lines but also those who are at certain levels above poverty rates. This includes nondisabled people and many more children.
At the same time, health care prices in Massachusetts have skyrocketed, with
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Barbara Anthony
Cambridge
The writer is a senior fellow at the Pioneer Institute and former undersecretary of the Massachusetts Office of Consumer Affairs and Business Regulation.
National health safety net is frayed enough as it is
Josh Archambault's op-ed does nothing to advance an important debate around our national health safety net. The situation is far more complicated than the talking points he offers.
An estimated
We have seen this before. When Arkansas and Georgia implemented work requirements, most of the people who lost coverage actually met the requirements but got caught up in red tape. We hear from callers every day on
We stand with the Massachusetts congressional delegation in pushing back against the unprecedented health care cuts in the House bill.
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Amy Rosenthal
Executive director
Health Care for All
Boston
Instead of prodding the 'able-bodied,' strengthen workforce development
Josh Archambault's argument that imposing work requirements on 'able-bodied' adults who receive Medicaid will improve health is wrong on several levels.
First, multiple evaluations of the Affordable Care Act Medicaid expansion demonstrate improved health overall and improved outcomes for specific populations (for example, reduced deaths from opioid use). The
Second, evaluations of the impact of work requirements for welfare recipients have generally shown the initial increased work participation failed to sustain income or reduce poverty over time because of low wages and insufficient work supports.
Third, to get Medicaid via disability, people must meet strict Social Security definitions of disability — a high severity bar — and large numbers of people with significant disabilities do not. Many of the 'nondisabled' childless adults on Medicaid have major mental health conditions, substance use disorders, and developmental disorders, including autism, that significantly affect their ability to succeed in the workforce. The population of low-income adults who became eligible for Medicaid through the Affordable Care Act also includes many parents, who too would be subject to paperwork burdens every six months.
Work that provides a living wage is a desirable outcome. Rather than imposing burdensome administrative requirements, real reform means strengthening workforce development policies — at all ages — through apprenticeship programs, other training work, coaching, reliable hours and transportation, and other policies that encourage jobs for previously unemployed people.
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Real reform also means strengthening health care prevention and promotion. MassHealth has taken clear leadership in promoting comprehensive primary care by transforming payment systems and providing incentives for team care, including the integration of mental-behavioral health care. Such efforts should be amplified rather than impeded through work requirement efforts.
Dr. James M. Perrin
Boston
Dr. Charles J. Homer
Brookline
Perrin is a professor emeritus of pediatrics at Harvard Medical School and John C. Robinson Distinguished Chair in Pediatrics at MassGeneral Brigham for Children and former president of the American Academy of Pediatrics. Homer is senior adviser at Economic Mobility Pathways and former deputy assistant secretary, human services policy, at the US Department of Health and Human Services.
The less fortunate don't need more hoops to jump through
There are a number of sleights of hand in Josh Archambault's call for Medicaid reform, not the least of which is judging a program that pays for access to our medical system by the outcomes provided by that system. But it's his call for government-mandated community engagement as a condition for having your doctor's visit subsidized that is truly gobsmacking.
It was not so long ago that such a proposal would be derided by conservatives as government social engineering because, among other things, it's literally that. Does Archambault truly believe that the federal government is capable of creating a meaningful social fabric for the less fortunate among us, or does he think that, as proven time and time again, adding requirements to social safety net benefits will simply discourage recipients from applying, thus reducing the costs of the programs?
Saul Tannenbaum
Boston
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Miami Herald
3 hours ago
- Miami Herald
Care about babies and moms? This Big Beautiful Bill cut should scare you
An unseen provision in the recent congressional overhaul of Medicaid will bankrupt poor families with sick newborns — and raise costs for us all. Hidden within the 940 pages of the One Big Beautiful Bill Act is a reduction in Medicaid's ability to pay for care retroactively (care that has already been delivered) from 90 to 60 days. Shortening this window of payment targets parents of newborns, and will burden families with thousands of dollars of medical debt. Neonatologists and pediatricians care for critically-ill babies, including those with prematurity or congenital heart or intestinal defects. Many of the premature infants we care for have missed an entire trimester of development. Weighing 1 to 2 pounds at birth, they must overcome underdeveloped lungs, brains and immune systems. Their complex and expensive care begins in the first seconds of life. There is no time to apply for Medicaid. 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San Francisco Chronicle
4 hours ago
- San Francisco Chronicle
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When Trump blasted Europe's progressive policies, more Americans sought to move there. And Trump's lawless immigration raids inspired dramatic changes in public support for immigrants. A record-high 79% of Americans now call immigration a 'good thing' for the country. Now Trump's mark is working its magic on high-speed rail. After nearly two decades of indifferent pursuit of the project, the state's leaders are rallying to defend it. After Trump's claw-back, California Attorney General Rob Bonta filed a lawsuit demanding all $4 billion returned. Gov. Gavin Newsom, long a skeptic on high-speed rail, now rallies behind it. The High-Speed Rail Authority, usually cautious politically, is blasting the Trump administration. Such shows of support are, put simply, unprecedented. While California Republicans have been most outspoken in criticizing high-speed rail, the state's Democratic establishment has been its real opposition. 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USA Today
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Will Rural America give up on Trump? These small-town activists think so.
Rural organizers say Medicaid and SNAP cuts could help Democrats win rural votes in 2026. Republicans say: Don't count on it. Dom Holmes, 28, has learned something important in 10 years of organizing progressives in rural Pennsylvania: You can't just show up when you need people to turn out to vote. You have to sit and listen to them. In recent weeks, when he's stopped to listen, he's gotten an earful about the tax and spending bill the Republican-led Congress passed in July. 'Folks are especially worried about how that's going to impact them at the local level,' he said. They're particularly "outraged," he said, about cuts to food stamps and Medicaid and the likely damage to rural hospitals. 'Folks should be aware of what the impact ‒ immediate and not ‒ will be on them and they should know who brought that impact to their community; who brought it home to them." 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They've seen a freeze on farm subsidies as well as an end to public land revenue and clean energy subsidies. 'When you put tariffs on top of Medicaid cuts and you put SNAP on top … and you put the rural services that are being defunded on top of everything else, it's just not sustainable.' Hildreth said. 'It's everything all at once and I honestly don't think anybody in the White House realizes that.' National Democrats and Republicans are busy during Congress' summer break The Democratic National Committee has invested in rural voter engagement for months, including billboard ads near rural hospitals that are likely to close because of the law, and contributed $22,500 a month to Democratic parties in red states and town halls in Republican held districts. "Donald Trump has been disastrous for our rural communities and the DNC will continue to show rural voters exactly how Trump and Republicans have betrayed them at every turn," DNC Deputy Executive Director Libby Schneider said in a statement. Republicans are spending the break talking up the tax and spending law, trying to combat Democrat's attempts to set the narrative that the bill is a tax cut for the rich that hurts the poor and middle class. 'Democrats have cemented their image as snobby, out of touch, and indifferent to the struggles of everyday Americans. They've abandoned rural America by voting against tax cuts, border security, and small businesses. While Democrats recycle fear and slogans, Republicans are delivering real results for working families," said NRCC Spokesman Mike Marinella in a statement. A NRCC memo to House Republicans obtained by Politico tells members that 'the best defense is a good offense,' and says that "this is a critical opportunity to continue to define how this legislation will help every voter and push back on Democrat fearmongering.' It highlights that Republican voters support work requirements and removing ineligible recipients from Medicaid insurance coverage, but the five-page memo doesn't explain how the GOP members of Congress should address the bill's expected hit to rural hospitals. Building on the momentum of protests Stephanie Porta, campaign manager of Battleground Alliance PAC, said progressive advocates in rural areas need to capitalize on the protests that millions of Americans have attended this spring and summer ‒ not just in big cities, but in rural towns. 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Proposed cuts are 'motivating folks to speak up' Lily Franklin often drives 10 minutes between houses when she knocks on doors in the Appalachian district where she is running to become a delegate to the Virginia House. She says people are worried about the future of rural health care access and Medicaid. 'There are a lot of hospitals that are at threat in this district, in this region. Folks are already driving an hour to an hour-and-a-half just to seek care,' she said. 'All of these proposed cuts are going to disproportionately hit southwest Virginia and it is motivating folks to speak up and say, hey this isn't what we wanted.' When she knocks on doors, she spends most of the time listening, she said. She grew up in the area and her family has been there for generations. 'They just haven't had anybody show up for them and meet them where they are at, and so half of the battle is talking to voters at their doors, hearing their stories and listening to them,' she said. 'People just want to be heard.' Even though she is running for the state general assembly, people want to talk about how worried they are about the future of rural health care access and Medicaid, she said. They are also worried about other aspects of the new law, like cuts to food benefits and energy assistance, which states will have to help pay for, she said. Franklin outperformed both President Joe Biden in 2020 and Vice President Harris in 2024. She lost her bid to represent the largely rural district that includes Blacksburg and Virginia Tech by just 183 votes. Franklin said several national groups have contacted her 2025 campaign because of how closely she came to flipping such a competitive seat in a rural area. She said Democrats can't swoop in with their messaging and expect it to resonate in every district. 'We've often tried to come up with a message that's hyper-tested in a lab somewhere, but realistically people just want to be heard. That's the secret sauce,' she said.
