Today, I wrote a piece for the New York Times titled “Medicaid Work Requirements Are Cruel and Pointless.” The post below about Medicaid utilization in SIPP is an accompaniment to that piece.
The New York Times recently ran an opinion piece from RFK Jr. and three other Trump administration officials in which they argue in favor of adding work requirements to Medicaid, the health insurance program for low-income Americans.
At one point in the piece, they write that:
A recent analysis from an economist at the American Enterprise Institute examined survey data from December 2022 (the most recent month available) and found that just 44 percent of able-bodied, working-age Medicaid beneficiaries without dependents worked at least 80 hours in that month.
I have produced figures like this in the past, typically by analyzing the Annual Social and Economic Supplement of the Current Population Survey (CPS ASEC). I found this particular estimate intriguing because it uses the Survey of Income and Program Participation (SIPP) rather than the CPS ASEC. So I figured I would dive into the SIPP to see what numbers it actually provides about this topic.
According to the SIPP, in December of 2022, the US population was 328.6 million people, of whom 73.2 million were receiving Medicaid.
Of those on Medicaid, 6.7 million are elderly, 29.3 million are children, and the remaining 37.2 million are working-age adults.
Of the working-age adults on Medicaid, 9.5 million are parents, 13.8 million are disabled, and 13.9 million are able-bodied adults without dependents (ABAWDs).
Of the ABAWDs on Medicaid, 8.1 million (58 percent) worked 80 or more hours in December of 2022. Another 1.5 million worked 80 or more hours in a prior month in 2022 while another 0.3 million had been enrolled in Medicaid for less than a year. Combining all three of these figures shows that there are only 4 million ABAWDS who are persistently enrolled in Medicaid and work fewer than 80 hours a month. This is about 29 percent of ABAWDs, 5 percent of all Medicaid recipients, and 1 percent of the US population.
My results significantly differ from the results published at AEI for two main reasons.
First, the AEI figures only count people as disabled if they are currently receiving SSI or some other kind of disability benefit. But not everyone who is disabled is currently receiving disability benefits. Some individuals have short-term disabilities. Others are receiving Medicaid while they work through the disability determination process, which can take years. Still others have fallen through the cracks of the disability benefit system in one way or another.
Luckily, in addition to collecting income information, SIPP directly asks people whether they have a disability that makes it difficult for them to work or find employment and asks people whether they have one of the six core disabilities — seeing, hearing, walking, dressing/bathing, doing errands alone, or cognitive problems — regularly tracked by the Census. Including individuals that answer yes to these questions results in another 8.8 million disabled people that AEI wrongly counts as able-bodied.
Second, in addition to looking at whether individuals worked 80+ hours in December 2022, I used the longitudinal features of the SIPP to see how many worked 80+ hours in one of the other months of 2022 and how many had been enrolled in Medicaid for less than a year. Individuals in these latter two groups are not persistently workless Medicaid users of the sort conservatives want people to believe are extremely numerous in the Medicaid system.
Once these changes are made, what we find is that 71 percent, rather than 44 percent, of ABAWDs on Medicaid are not persistently workless dole scroungers. Of course, some of the 4 million people who end up in the residual “Everyone Else” bucket above are students and people who simply cannot find a job despite trying. Absolutely none of this suggests there is a serious social problem here in need of addressing.