The Real Medicaid Fraud? Pretending That Work Requirements Work
By Wendell Potter
May 29, 2025
As Congress moves closer to turning the latest Republican reconciliation bill into law, let’s take a moment to cut through the political talking points and focus on how millions of working Americans will be harmed if the bill is enacted in its current form.
The proposed legislation not only slashes Medicaid funding, but it also adds strict work requirements that will add billions of dollars in administrative costs borne by taxpayers. It’s being framed as a crackdown on “welfare dependency.” But new research from the Center for Economic and Policy Research (CEPR) tells a very different story — one that many lawmakers and special interests in Washington conveniently leave out of their talking points.
Medicaid Covers People Who Are Already Working — Lots of Them
According to CEPR’s latest analysis, more than 15.9 million working Americans get their health insurance through Medicaid. These are not people sitting on their couches. Over half of them — 8.7 million — work full-time jobs. The vast majority (92%) are private-sector employees, and more than half have kids at home.
This is especially true for low-wage workers. Over 11 million of those enrolled in Medicaid are in the bottom 40% of the wage distribution, earning less than $22 an hour. These are the workers who are going to work day in and day out but still can’t afford basic health care coverage without public support, thanks to an insurance industry-controlled health care system that increasingly requires Americans to put more and more skin in the health care game.
What the Bill Doesn’t Do: Hold Big Insurance Accountable
What’s truly galling is that while lawmakers are eager to tighten the screws on Medicaid recipients — many of whom are poor, working parents — they’ve so far refused to rein in the real abusers of taxpayer dollars: big insurance conglomerates.
Lawmakers have to know that Medicare Advantage plans, run by the very same insurance giants that manage most states’ Medicaid programs (for hefty fees), are overpaid $84 billion a year by even the most conservative estimates. The nonpartisan Medicare Payment Advisory Commission has been waving red flags about this for years. So have other advocacy and watchdog groups. But Washington continues to look the other way.
Medicare Payment Advisory Commission’s news release regarding Medicare Advantage overpayments.
Insurers manipulate coding to make patients look sicker than they are (a tactic known as “upcoding”) and use narrow networks and prior authorization requirements that make it more and more difficult for patients to get the care they need. These practices enable insurers to grab billions of taxpayers’ money they are not entitled to — a game that shifts profits to Wall Street while keeping many legitimately sick people from accessing often life-saving medical care.
And yet, in this budget bill, not a single provision addresses…
[READ THE COMPLETE ARTICLE HERE]