MAGA vs. Medicaid: When the Narrative Doesn’t Survive First Contact
The idea that Medicaid is a handout for lazy, able-bodied freeloaders falls apart the moment it meets real-world data
“The great enemy of truth is very often not the lie…but the myth—persistent, persuasive, and unrealistic.”
—John F. Kennedy
Friday morning, as I sat down to review the June Jobs Report, I couldn’t shake something I read Thursday night on Alligator Jackson’s Facebook page. He’s a kind of local Facebook legend in my hometown of Huntington, West Virginia. The thread was about the so-called “Big Beautiful Bill,” the MAGA movement’s latest push to “fix” Medicaid. The comments were a familiar stew of contempt, misinformation, and cultural resentment: accusations that people on Medicaid are lazy, fraudulent, and undeserving. More than a few claimed this bill would finally strip the freeloaders and “illegals” of their free ride. But here’s the catch. Nearly 35% of West Virginians are on Medicaid, and the state’s unemployment rate is around 5%. If Medicaid were just a couch magnet for the idle, those numbers wouldn’t make sense. And they don’t, because the narrative doesn’t.
The MAGA worldview paints Medicaid as a bloated safety net for people who could work but choose not to. According to this line of thinking, attaching work requirements will compel the able-bodied to return to the labor force and save the system from abuse. It’s an emotionally satisfying story, but the data makes a mockery of it.
According to a 2023 microdata analysis by the Kaiser Family Foundation, 64% of non-disabled adult Medicaid recipients already work. Many of them full-time. Another 28% are either caregivers, full-time students, or suffering from an illness or temporary disability that qualifies them for an exemption. That leaves just 8% of enrollees who are neither working nor exempt under previous federal standards. In other words, the “freeloader” narrative applies to a sliver of recipients, a fraction that can’t possibly justify the structural overhauls being proposed. And for those challenged by math, that means 92% of adult Medicaid recipients immediately qualify under traditional rules.
The broader labor market underscores this. The U.S. unemployment rate is just 4.1%. According to the Bureau of Labor Statistics, more than 6.4 million Americans worked at least 27 weeks in 2022 and still lived below the poverty line. As of June 2025, 8.7 million people held multiple jobs. These aren’t people “sitting around.” They are the underpaid, the uninsured, and the indispensable. These are people who clean your hotel room, deliver your groceries, and care for your grandmother. Medicaid doesn’t coddle them. It keeps them from collapsing.
And when this ideological project has been tested, the results have been disastrous. In 2018, Arkansas became the first state to implement Medicaid work requirements under a Trump administration waiver. Over 18,000 people lost coverage. Not because they refused to work, but because of burdensome reporting systems, bureaucratic confusion, and sheer lack of awareness. Follow-up surveys showed no meaningful increase in employment. And no surprise there. A large majority of those kicked off the rolls were, in fact, already working. What changed wasn't their behavior. What changed was their insurance status. They simply became uninsured. And sicker.
Still, some argue that work requirements are about personal responsibility, not savings. Even if most people are already working, shouldn’t the program require it just to keep people honest? It’s a reasonable impulse. But the problem isn’t the intent. It’s the implementation. And let me be blunt. The paperwork is no joke. I just retired from the military, and even with a clean service record and financial stability, navigating the VA was a bureaucratic nightmare. I was lucky. I had the funds and the wherewithal to work with the VFW to guide me through it. Most people on Medicaid don’t have that kind of institutional backup. They’re on their own in a system built like an obstacle course.
It reminded me that it doesn't take much for frustration with a system to spiral into distrust of the whole thing. This morning, while I was on hold with UPS trying to fix a shipping issue, I caught myself doing something all too human. After a frustrating experience with one or two customer service agents, I started questioning the competence of the entire organization. And it hit me. How often do we do that with people? We see one person who appears to be gaming Medicaid, and we extrapolate that to everyone. That one anecdote becomes the entire narrative. What does that say about us? About our instincts? It might be efficient pattern recognition. But it’s also how empathy dies in bureaucratic silence.
Work-verification systems disproportionately harm people with inconsistent hours, caregiving responsibilities, or digital access issues. The exemptions are complex and poorly communicated. States often spend more on compliance than they save in fraudulent claims. These systems function like a bureaucratic wall. Not to stop fraud, but to discourage participation.
And we’re not just talking about working-age adults. Nearly 40 percent of all Medicaid recipients are children, and millions more are people in life transitions. Between jobs, postpartum, recovering from illness, or navigating a divorce or family crisis. These aren’t edge cases. They’re the reality for huge swaths of the population. Medicaid isn’t just a health insurance program. In many parts of the country, it’s a financial pillar that keeps rural hospitals open and local economies afloat. When states impose rigid work rules, they don’t just cut coverage. They destabilize entire care systems. And the impact isn’t distributed equally. These policies fall hardest on Black and Brown communities, rural residents, and people without reliable internet access or transportation. That’s not about fairness. That’s about engineering failure.
As a strategist, one of my responsibilities was always to Red Team. To pressure-test assumptions and play devil’s advocate. So these are arguments I’ve thought about. The counter-argument goes something like this: Medicaid may provide coverage, but it doesn’t necessarily deliver value. Critics argue that expanding it without guardrails risks locking people into a government program with poor health outcomes, limited provider access, and weak incentives to move up the income ladder. From this view, the program disincentivizes work by creating a benefits cliff just above the poverty line. They also contend that states, flush with federal matching funds, have little reason to control costs or innovate. If we’re serious about promoting long-term mobility, they say, we should be helping low-income Americans transition into private insurance, not cementing their reliance on Medicaid. In this light, work requirements aren’t about cruelty. They’re about aligning benefits with economic participation. These arguments may hold water in theory, but so far they haven’t produced policies that actually solve the problems they point to. In practice, they’ve mostly added complexity, churn, and coverage loss.
This is where I part ways with the idea of “pathways to private coverage.” I don’t think the future of health care in America lies in subsidizing insurance corporations. I think the United States should be out of the insurance business altogether. If the Constitution were written today, the Founding Fathers might well agree that health care is a fundamental right. Benjamin Franklin championed a “free of charge” hospital for Philadelphia’s sick-poor in 1751, arguing such care served civic health and public safety. That sense of health care as a communal responsibility carries through the General Welfare Clause, interpreted early on to allow spending on public benefits. We’ve tied health care to employment and to insurance for too long. That’s why we’re in the crisis we’re in now.
If the federal government were serious about Medicaid integrity, it would do two things. Neither of which would fly in today’s political environment. First, the Department of Health and Human Services should establish a division in coordination with the states to assist applicants through the Medicaid process. Not a gatekeeper, and not an office designed to weed people out. A proactive entity that ensures eligible Americans can get enrolled. Second, the Department of Justice should stand up a Medicaid enforcement division focused on investigating and prosecuting actual fraud. Not imagined fraud. Not “welfare queen” mythmaking. Actual, provable abuse of the system. Make access easier for those who qualify, and make it riskier for those who break the law.
The truth is, America has a working-poor problem, not a laziness problem. Medicaid isn’t a magnet for freeloaders. It’s a backstop for people who play by the rules and still can’t afford to see a doctor. The MAGA narrative collapses under the weight of its own fiction. And the moment it comes into contact with reality (whether it’s a federal data set, a policy case study, or a Facebook comment thread), it doesn’t survive. And the irony? The greatest communicators of disinformation are often the ones pointing the finger at their neighbor.
Biblography
Alker, Joan. “One Big Beautiful Bill Act: Winners and Losers in the Medicaid Provisions.” Georgetown University Health Policy Institute, Center for Children and Families, June 26, 2025. https://ccf.georgetown.edu/2025/06/26/one-big-beautiful-bill-act-winners-and-losers-in-the-medicaid-provisions/
Arkansas Department of Human Services. Arkansas Works Program Data. Little Rock: DHS Office of Policy and Planning, 2019. https://humanservices.arkansas.gov/newsroom/medicaid-arworks-and-other-reports/
Bureau of Labor Statistics. “A Profile of the Working Poor, 2022.” U.S. Department of Labor, April 2023. https://www.bls.gov/opub/reports/working-poor/2022/
Bureau of Labor Statistics. “Employment Situation Summary – June 2025.” U.S. Department of Labor, July 2025. https://www.bls.gov/news.release/empsit.nr0.htm
Franklin, Benjamin. Autobiography and Other Writings. Edited by Kenneth Silverman. New York: Penguin Books, 2003.
Kaiser Family Foundation. “Understanding the Health Coverage of Nonelderly Adults in Medicaid.” February 2023. https://www.kff.org/health-policy-101-the-uninsured-population-and-health-coverage
Karpman, Michael, and Anuj Gangopadhyaya. “New Evidence Confirms Arkansas’s Medicaid Work Requirement Did Not Boost Employment.” Urban Institute, April 23, 2025. https://www.urban.org/research/publication/new-evidence-confirms-arkansas-medicaid-work-requirement-did-not-boost-employment
Sommers, Benjamin D., et al. “Medicaid Work Requirements – Results from the First Year in Arkansas.” New England Journal of Medicine 381, no. 11 (2019): 1073–82 https://www.nejm.org/doi/full/10.1056/NEJMsr1901772
University of Pennsylvania Archives. “1751: Founding of Pennsylvania Hospital.” https://www.uphs.upenn.edu/paharc/timeline/1751/
Thanks, Darrell, and thanks for commenting. I think that is an absolutely valid point. The methodology on several fronts, like voter rights, is the playbook they are using on most issues, including Medicaid and immigration.
This is really well done. Bravo. You've done a masterful job at summarizing the issue and removing all the smoke. As I was reading this, I couldn't help but think of how the Republican party at large has been chipping away at voter rights for years, typically under the cloud of imagined fraud. Rather than making voting easier, more efficient, more accessible, they've done just the opposite, knowing full well the demographic that would be most impacted in a very tight election.