Nebraska just became the first state to tell poor people they need to file monthly paperwork proving they work 80 hours to keep their health insurance. Miss the form or confuse DHHS’s bureaucracy — coverage gone. Not because you stopped working. Because you failed a government quiz while sick and broke.
This is what “work requirements” actually are. Not a ladder, not a job program — a filter. The Urban Institute says Nebraska alone will kick 25,000 people off Medicaid from this. The CBO found that work requirements will strip coverage from over 5 million Americans by 2034 and produce little to no increase in employment. So it’s not about getting people working. The people who lose coverage are mostly already working — they lose it because the form is confusing and they’re busy being poor. Dr. Oz was at the Nebraska launch announcement, grinning. That’s your tell.
The Big Beautiful Bill is cutting $1 trillion from Medicaid over the next decade. Work requirements are the framing that makes that number sound righteous. Call it accountability, call it community engagement, call it whatever makes the chart look like a life lesson instead of a body count. It’s bureaucratic attrition. The paperwork does the dirty work so the politicians don’t have to.