• As Congressional Republicans try to pass President Donald Trump’s ‘big, beautiful bill’ through the House and Senate, Medicaid is one of the big programs in the party’s legislative crosshairs. GOP lawmakers are eyeing upwards of $800 billion in cuts to the safety net health care program over the next decade, in part by imposing new work and eligibility requirements for recipients. But while the president keeps insisting ‘no cuts to Medicaid,’ the government’s calculations suggest the party’s plan could cost 10 million Americans their health care coverage. Matt Bruenig, founder of the People’s Policy Project, explains why work requirements don’t work.
• And in headlines: Secretary of Homeland Security Kristi Noem got her constitutional rights all mixed up during a Senate hearing, Trump’s FDA looks to limit access to Covid booster shots, and New Jersey U.S. Congresswoman LaMonica McIver is charged with assault.

• Check out Matt’s column –www.nytimes.com/2025/05/16/opinion/medicaid-work-requirements-pointless.html
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TRANSCRIPT

 

Jane Coaston: It’s Wednesday, May 21st. I’m Jane Coaston, and this is What a Day, a show that recalls a time when congressional hearings for members of a presidential administration involved way less screaming. It’s crazy, but it’s true. [music break] On today’s show, Secretary of Homeland Security Kristi Noem gets her constitutional rights all mixed up during a Senate hearing. And Trump’s FDA looks to limit access to COVID booster shots. But let’s start with Medicaid. We’ve been talking about Medicaid a lot on this show. As a refresher, it’s the healthcare safety net program that primarily covers low-income Americans, and it’s jointly run by the federal government and states. It’s also in the crosshairs of congressional Republicans as they try to move President Donald Trump’s big, beautiful bill slowly, painfully, through the House and Senate and onto his desk. They’re eyeing upwards of $800 billion in cuts to Medicaid over the next decade. And one of the ways they want to do that is by imposing new work and eligibility requirements. But if you’re just listening to Trump talk, you’d honestly never know it. Because the president seems to be very into Medicaid. Here he is Monday at the tail end of an unrelated press conference in the Oval Office. 

 

[clip of President Donald Trump] Thank you. No cuts no cuts to Medicaid. No cuts to Medicaid.

 

Jane Coaston: And earlier in the day, Trump went to Capitol Hill to strong-arm Republicans into passing his big legislative agenda. And he reportedly told lawmakers, quote, “don’t fuck around with Medicaid.” But despite Trump’s efforts to use the power of positive thinking and mob boss threats to change the minds of the GOP, inspirational to me, really. Republicans are, in fact, fucking around with medicaid. All that money for tax cuts has to come from somewhere. Why not poor people’s health care coverage? Am I right? And I’ve been noticing something. Despite the fact that Medicaid covers more than 70 million Americans, it appears many people, including a ton of Republicans, don’t seem to know much of anything about the people on it. For example, here’s Florida Republican Senator Rick Scott on Fox News. 

 

[clip of Senator Rick Scott] If you don’t want to work, you’re the one that decided you don’t want health care. That’s number one. Number two, Medicaid is supposed to be for children that don’t have health care and people with chronic illness. 

 

Jane Coaston: Also, for eligible low-income adults to quote Medicaid’s own website if we’re picking nits here. And here’s Louisiana Republican Representative Steve Scalise on CNBC. 

 

[clip of Representative Steve Scalise] If somebody’s able-bodied and they can go get a job and they’re living in their mom’s basement playing video games, I’m sorry, you gotta go get a job. This program was designed for the truly needy, the disabled people, pregnant women, seniors. 

 

Jane Coaston: And eligible low-income adults. Why do they keep forgetting that part? Anyway, based on how those two titans of Congress talk about Medicaid, it’s not surprising that many Americans support work requirements for the people on it. But here’s the thing. Most working-age adults on Medicaid work. According to data from the non-partisan health research firm KFF, nearly two-thirds of adults covered by the program were working in 2023. And most of those who weren’t were caregiving, managing illness or disability, or were in school. Perhaps Senator Scott and Representative Scalise aren’t being intellectually honest with the American people about their plans that could cost an estimated 10 million Americans their healthcare coverage, according to the nonpartisan Congressional Budget Office? No. What? No. So to learn more about work requirements for Medicaid and why they are a not very good idea, I spoke with Matt Bruenig. He’s the founder of the People’s Policy Project, a think tank focused on social and political equity issues. And he wrote a recent New York Times op-ed titled, Medicaid Work Requirements Are Cruel and Pointless. Matt, welcome to What a Day. 

 

Matt Bruenig: Oh, thanks for having me. 

 

Jane Coaston: Okay, so before we get into the moral and practical reasons you oppose work requirements for Medicaid, can you explain how they would work in theory as laid out in this Republican spending plan that’s being debated right now? 

 

Matt Bruenig: In theory, every month you’re going to tell the state Medicaid agency how many hours you worked. Um. And if you’re above 80, then you can continue to receive benefits. Um. And if you’re below 80, you will be cut off of benefits. That is, if you are otherwise non-disabled, not a child, not old, um you know, after you clear those bars, you’d have to clear 80 hours a month of work. 

 

Jane Coaston: Right. So who would this apply to? Because there are a lot of people who obviously are receiving Medicaid, who are taking care of a sick parent or might be in school. So it wouldn’t apply to those people, correct?

 

Matt Bruenig: Uh, it could apply to someone in school, but–

 

Jane Coaston: Okay. 

 

Matt Bruenig: Uh, yeah, when you think about the entire Medicaid population, about half are children or elderly, so they’re not going to be affected by it, then, uh of the remaining half, about half of those are working. Um, and then another quarter are disabled and so on and so forth. But you know, the main population is going to be somewhere around maybe about 20% of the working-age population who are on Medicaid could end up getting dinged one way or another by it. 

 

Jane Coaston: Broadly speaking, work requirements for government aid are popular. A recent poll from the non-partisan research firm KFF found that close to two-thirds of Americans back them, including nearly half of Democrats. So why is it broadly popular? 

 

Matt Bruenig: Yeah, so that poll actually um you know asked a second question where they confronted people with you know the low amount of people who are on these benefits who are out of work and on a long-term basis. And when you tell people, oh, actually there really aren’t that many people who are just persistently out of work on Medicaid or food stamps or whatever, then the support for the work requirements goes down, actually below 50%. So what that seems to suggest is a lot of people just think that the Medicaid rolls are just full of unemployed people who just persistently don’t work. And this has kind of been a trope in welfare policy for ever and ever and ever. 

 

Jane Coaston: Right, right. I think that, you know, Reagan’s Welfare Queen is probably the most famous example of that. But you’re hearing that a lot right now this week of Republicans talking about how there are all these unemployed dudes living in their basements who are not working and don’t want to work and that’s why we have to have work requirements. But given the level of federal spending on Medicaid, more than $600 billion in fiscal year 2023, are work requirements not a better middle ground than say finding savings by cutting parts of the program? Which voters do not want. 

 

Matt Bruenig: Yeah, I mean, I don’t know. When you start deciding what you want to cut from it, I’m not sure, it’s all it’s all very important. Um. I think one of the issues with work requirements is that it’s gonna ding a lot of people that you don’t expect to ding. So even if you wanna say, well, there’s gotta be at least some people on the rolls who are these, you know, basement dwelling video gamers who, you know, just refuse to work. Um. Like you know, there’s 330 million people in the country. It’s there’s gotta be some. There just have to be. Um. Your ability to locate those people in a systematic way and cull them from the rolls is very, very limited. Um. And what you’ll end up doing is you’re gonna end up hitting a lot of people who you don’t expect to hit. In fact, probably far more people that you don’t expect to hit than uh the people who you’re trying to get off the rolls. So um, to me, increasing administrative burdens in this way, that’s just gonna kind of create a sort of random assortment of people who mostly just can’t report their hours accurately um is not is not a good way to go. 

 

Jane Coaston: Yeah, I think that that gets us into the moral and practical reasons why you say work requirements for Medicaid don’t work. And the main argument you lay out in your New York Times op-ed is that Medicaid was designed to be a backstop for people who are out of work. Can you explain that a little bit more? 

 

Matt Bruenig: Yeah, I mean, when you think about in the post-Obamacare healthcare system that we have, if you’re employed, you typically get employer-sponsored insurance, or maybe not, you can get an Obamacare exchange plan. And if you lose your job, well, now you don’t have income, the only place for you to go is Medicaid. And so there’s something a little contradictory about saying, well we wanna get all these people who aren’t working off of Medicaid. That’s where you go when you aren’t working. You know I’ve lost a job before and I was unemployed for two or three months. Um. There’s nowhere else to go. You can’t buy an exchange plan. You can’t get Medicare. You’re not old enough. Um. I’m not a veteran. I can’t get Tricare. Like that’s the only place in the system to go, so unless you’re basically saying, hey, when people lose their jobs, we just don’t want them to have health insurance, this kind of plan doesn’t make sense. 

 

Jane Coaston: And, as you mentioned, too, it’s also true that a lot of people who rely on Medicaid do have jobs. Their employers may just not provide health insurance, or they don’t work enough hours every week to qualify for it. So even though they’re not nominally affected by these work requirements, what would imposing them mean for their ability to maintain them? 

 

Matt Bruenig: Yeah, no, they have to now start reporting their hours. And that’s not a thing you do already in the system. You do have to kind of report your earnings periodically to make sure that you’re still below the income cutoff, but you don’t report hours. And there’s really no other place that we report hours except employers will report your hours either quarterly or annually to the state unemployment office. But the idea of reporting it every month or having to separately report it, to the Medicaid office, which is going to be your obligation, not the obligation of your employers. Um. That’s not something that exists. So you may not even be able to get it. Um. I think about someone who’s an Uber driver, for instance. 

 

Jane Coaston: Right. 

 

Matt Bruenig: I know Uber drivers who are on Medicaid. Um. How many hours do they work? I don’t know. I mean, their rides are timed, but obviously they spend a lot of time [?]– 

 

Jane Coaston: Driving in between rides or something like that. 

 

Matt Bruenig: Yeah, so what’s an what’s an hour for an independent contractor? What’s an hour for a handyman for someone who mows lawns for someone who paint houses for someone who cleans, these things are how do you prove these things? 

 

Jane Coaston: Yeah, and it just goes to, Republicans argue these requirements will push more people into the workforce, but as we’ve been talking about, a lot of these people are already in the workforce. And you say, quote, “work requirements are a solution to a problem that doesn’t exist.” Can you explain what you mean there? 

 

Matt Bruenig: I mean, the supposed problem is that there’s a lot of people who just persistently sit on Medicaid, um who are able-bodied adults, who don’t have dependents, and that just isn’t true. Um. The numbers that I came up with with the current population survey, is that about that describes about 3% of all Medicaid recipients. And that’s without even looking into those recipients. Some of those are college students. They might have some extenuating circumstances, who knows? It’s just not a huge issue. Um. The only way it’s going to save benefits is by hitting other people who you don’t intend to actually kick off the program, people who will fail to uh you know report their hours correctly. 

 

Jane Coaston: Now, a handful of states have tried to impose these work requirements, Arkansas, Georgia. What did they find? Did they find all these savings that Republicans are now promising? Because it sounds like no. 

 

Matt Bruenig: No, I mean in in Trump one, um they put out a rule saying that states would be given waivers to implement work requirements. Arkansas took advantage of that waiver, implemented it, and kicked off 18,000 adults in four months. Um. Subsequently, a judge halted it and said they couldn’t do it. Um. But during that period, they removed those adults and that created a obviously very fertile environment for researchers to go in and say, well, what happened to those adults what happened to employment in Arkansas. We can compare it to all these other states that didn’t impose it and they find no impact on employment. 

 

Jane Coaston: So, if this bill makes it to President Trump’s desk, and that is a giant if, what would it mean for the more than 70 million Americans who are enrolled in Medicaid? 

 

Matt Bruenig: I mean, for most of them, it’s going to just be a huge hassle. A lot of people will be cut off the rolls, um you know, and then they’ll have to turn around and fight to try to get back on them. And now you’re in a situation where, you know, if a medical emergency hits you or some kind of or if you’re dealing with some kind of chronic illness, which is probably the worst case scenario, you’re just you’re just going to be out of luck. You’re not going to able to afford health care, um, and I mean, people will die, honestly. I mean that’s the bottom line here. People will die and and others will suffer. 

 

Jane Coaston: Matt, thank you so much for your time. 

 

Matt Bruenig: Thank you. 

 

Jane Coaston: That was my conversation with Matt Bruenig, founder of the People’s Policy Project. We’ll link to his op-ed in the Times in our show notes. We’ll get to more of the news in a moment, but if you like the show, make sure to subscribe, leave a five-star review on Apple Podcasts, watch us on YouTube, and share with your friends. More to come after some ads. [music break]

 

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Jane Coaston: Here’s what else we’re following today. 

 

[sung] Headlines. 

 

[clip of unnamed Senate Committee person] Secretary Noem, please stand and raise your right hand. Do you swear the testimony you will give before this committee will be the truth, the whole truth, and nothing but the truth? So help you God?

 

Jane Coaston: Secretary of Homeland Security Kristi Noem testified before the Senate Committee on Homeland Security and Governmental Affairs on Tuesday. She was there to discuss her department’s 2026 budget. Noem also performed a masterclass in attempting to fake it till you make it when she was asked by Senator Maggie Hassan of New Hampshire to define habeas corpus. 

 

[clip of Senator Maggie Hassan] Secretary Noem, what is habeas corpus? 

 

[clip of Kristi Noem] Well habeas corpus is a constitutional right that the president has to be able to remove people from this country. 

 

Jane Coaston: No, no, mm-mm. Unfortunately for Secretary Noem, Senator Hassan appears to actually know the definition of the term habeas corpus. 

 

[clip of Senator Maggie Hassan] Excuse me, that’s that’s incorrect. 

 

[clip of Kristi Noem] President Lincoln used it. 

 

[clip of Senator Maggie Hassan] Excuse me. Habeas corpus is the legal principle that requires that the government provide a public reason for detaining and imprisoning people. If not for that protection, the government could simply arrest people, including American citizens, and hold them indefinitely for no reason. 

 

Jane Coaston: You know, that’s the constitutional right your department is accused of violating in its draconian immigration crackdown, Madam Secretary. Senator Hassan’s question to Noem came in response to remarks made earlier this month by White House Deputy Chief of Staff Stephen Miller. He said that the White House was actively looking at suspending habeas corpus as part of the Trump administration’s mass deportation efforts. Noem did talk some business of a hearing. She was questioned by multiple senators about the Trump administration’s nearly 500 million dollars in proposed cuts to the Cyber security and Infrastructure Security Agency, or CISA. Noem remained vague on how exactly the cuts would be achieved, instead echoing comments she’s made previously insinuating that CISA is responsible for political censorship and that the agency needs to get, quote, “back on mission.” 

 

Speaker 10 We were third in space, and now we’re number one in space by a lot. It’s not even close. 

 

Jane Coaston: During a Tuesday afternoon press conference in the Oval Office, President Donald Trump announced a major defense project that is intended to protect the U.S. from missiles launched from all over the globe and even space. Trump, famously a lover of gold, is calling it the Golden Dome. And of course, it will be quote, “the best system ever built.” The president estimated that the total cost of the project will come to $175 billion, $25 billion of which would be set aside in his one big beautiful bill. Trump also announced that Space Force General Michael Guttlein would head up the project. Last month, it was reported that Elon Musk’s SpaceX is among the front-runners to win a lucrative contract in the construction of the Golden Dome. 

 

[clip of President Donald Trump] This is very important for the success and even survival of our country. It’s a pretty evil world out there. 

 

Jane Coaston: Now, it’s worth noting that according to reporting from the New York Post, SpaceX would want the Golden Dome to operate as a subscription service that the government would pay for access to. Like Netflix, but for missile defense. Sure.

 

[clip of Representative LaMonica McIver] We’ve seen this administration come after and attack you know leaders for doing their jobs. Um. It’s political intimidation, and I will not be intimidated. I expect to continue to do my job. 

 

Jane Coaston: Democratic Representative LaMonica McIver of New Jersey is facing charges for allegedly assaulting two federal agents outside a migrant detention facility while trying to block the mayor of Newark from being arrested. McIver was part of a congressional delegation visiting the Delaney Hall facility in Newark, where immigration and customs enforcement had begun holding detainees. In a complaint made public Tuesday, the government alleges McIver assaulted Homeland security and ICE agents while protesting the arrest of Mayor Ras Baraka. Interim U.S. Attorney for the District of New Jersey, Alina Habba, announced the charges in a statement shared on Twitter. She said Baraka’s misdemeanor trespassing charge was dismissed for, quote, the sake of moving forward. But Habba said McIver’s conduct can’t be overlooked. In a statement, McIvers said, quote, “the charges against me are purely political. They mischaracterize and distort my actions and are meant to criminalize and deter legislative oversight.” 

 

[clip of unnamed person] The truth is that for many Americans, we simply do not know the answer to whether or not they should be getting the seventh or eighth or ninth or 10th COVID-19 booster. 

 

Jane Coaston: FDA vaccine chief Dr. Vinay Prasad announced on Tuesday that the agency will no longer provide universal access to annual COVID boosters. In a major policy shift, the FDA is raising the standard of proof required to approve the shot for healthy Americans between 6 months and 64 years of age. Until now, new COVID boasters were approved annually by the FDA, when manufacturers could show that the latest version provided as much immune protection as the previous year’s version. Now, the FDA is trying something new with your health. It’s requiring new randomized control trials to prove that the COVID vaccines are still safe and effective before approving them for most Americans. Dr. Prasad said that vaccine approval for older adults and those with high risk factors would remain streamlined. Dr.Prasad has been an outspoken critic of the FDA’s response to the COVID-19 pandemic. In a 2021 blog post, he suggested that the federal government could use the pandemic as an excuse to end democracy and stand up a totalitarian regime in the U.S. And that’s the news. [music break] One more thing. What exactly does Health and Human Services Secretary Robert F. Kennedy Jr. do all day? Swim in jeans? Swim in jeans in a creek of human sewage? Eat french fries cooked in tallow? Because whatever it is he does, it definitely doesn’t seem to be managing the day-to-day operations of the Department of Health and human services. Case in point. On Tuesday, Kennedy appeared before the Senate Appropriations Subcommittee to discuss Trump’s 2026 budget request for the agency he allegedly runs. I say allegedly, because when questioned by Illinois Democratic Senator Dick Durbin about cuts to ALS research and the effects those cuts would have on one of his constituents who’s been diagnosed with the disease, Kennedy appear to have absolutely no idea what the hell was going on in his own damn department. 

 

[clip of Senator Dick Durbin] How can we possibly address his concerns and give hope to people across the country who are suffering from so many diseases when our government is cutting back on that research? 

 

[clip of Robert F. Kennedy Jr.] As I said, uh Senator, I do not know about any cuts to ALS research and I’m happy to meet with you. 

 

[clip of Senator Dick Durbin] I just read them to you. 

 

[clip of Robert F. Kennedy Jr.] I will have to go and talk with Jay Bhattacharya and find out what the rationale was for those cuts. I just don’t know about them until you told me about them at this moment. 

 

Jane Coaston: Yes, do that, please. Here’s why this drew my attention. A month ago, my mom died. You may have known that. You may not have known that she died of amyotrophic lateral sclerosis, also known as ALS, sometimes called Lou Gehrig’s disease. Here’s what ALS did to my mother. It stole her ability to speak first, slurring her speech and then making it impossible for her to talk altogether, which was hard because my mom loved to talk to anyone and everyone. ALS then made it so she couldn’t swallow easily, making it difficult and very embarrassing for her to try to eat in front of other people. And then ALS made eating impossible. And my mom loved food, both cooking and eating. I used to tell her it was too bad the Third Amendment existed, because she would have really enjoyed cooking for an entire army garrison stationed in her house. She got a feeding tube installed in November. She hated it. My mom loved to swim. She could spend hours in the pool my dad built for her the summer I was born. But because of ALS, she lost so much weight and so much muscle that she couldn’t swim anymore. She started falling, stopped being able to walk. She developed frontotemporal dementia, which impacts about half of ALS patients and took away her ability to control her facial expressions. And ultimately, ALS took my mom’s life. She died at home in her own bed, as she demanded. Because though she couldn’t speak, she could give a thumbs down to the hospice nurse who asked her if she wanted a hospital bed instead. According to the ALS Association, every 90 minutes someone is diagnosed with ALS and someone dies of the disease, because ALS is always fatal. And I don’t wish that on anyone, anyone. There are researchers who have been working on ways to slow down the progression of ALS and someday maybe even create a cure. But the Department of Health and Human Services has proposed eliminating the government’s centralized database that tracks ALS cases. It wants to cut funding for the researchers who could save someone else’s mom’s life. And RFK Jr., whose job it is to run this department, doesn’t know anything about it. Or, I’d argue, doesn’t care. I think Maryland Democratic Senator Angela Alsobrooks put it correctly last week. 

 

[clip of Senator Angela Alsobrooks] You’ve been unable to answer a specific question, sir. You are the wrong person for this job.

 

Jane Coaston: I’d only add one more thing. Robert F. Kennedy Jr., go fuck yourself. [music break] That’s all for today. If you like the show, make sure you subscribe, leave a review, think of the man who paid more than $600 for a rump watch, and tell your friends to listen. And if you’re into reading, and not just about how a Pennsylvania couple paid actually $640 for a Trump watch, but got a watch that said rump, like me, What a Day is also a nightly newsletter. Check it out and subscribe at Crooked.com/subscribe. I’m Jane Coaston, and honestly, what’s the difference? [music break] What a Day is a production of Crooked Media. It’s recorded and mixed by Desmond Taylor. Our associate producers are Raven Yamamoto and Emily Fohr. Our producer is Michell Eloy. We had production help today from Johanna Case, Joseph Dutra, Greg Walters, and Julia Claire. Our senior producer is Erica Morrison, and our executive producer is Adriene Hill. Our theme music is by Colin Gilliard and Kashaka. Our production staff is proudly unionized with the Writers Guild of America East. [music break]

 

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