The VP Debate May Focus on the “Working Class,” But Will They Discuss Medicaid? 

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Tomorrow’s vice presidential debate between Senator JD Vance of Ohio and Governor Tim Walz of Minnesota will likely feature a contrast between conservative and liberal ideologies. While there are many differences between the presidential campaigns, some of the widest differences may be related to Medicaid, the program that provides health coverage and access to long-term care for low-income Americans and many low-wage workers. 

Initially linked to cash-benefits, Medicaid has expanded over the years, particularly for children and pregnant women, and the Affordable Care Act (ACA) expanded coverage to more low-income adults who had previously been excluded from coverage. Despite the delinking of Medicaid coverage from cash benefits over time, KFF President and CEO Drew Altman in a recent column described the collision of world views on Medicaid: Over half of Republicans (54%) view Medicaid as welfare compared to nearly 8 in 10 Democrats (79%) that view Medicaid primarily as a health insurance program.

The majority of adults on Medicaid are working, and those not working cite barriers to work, including caregiving, illness or disability, school, or inability to find work.

Former President Trump has favored work requirements in Medicaid and approved demonstration waivers that allowed states to condition Medicaid eligibility on meeting a work and reporting requirements. The Biden-Harris administration reversed course and withdrew Medicaid work requirement waivers. Broader Republican proposals continue to support legislative changes to allow or require work requirements in Medicaid.

Research shows that Medicaid can support employment by providing health coverage and access to care and medications that enable people to work. In an examination of a national work requirement, the Congressional Budget Office stated that “federal costs would decrease, the number of people without health insurance would increase, the employment status of and hours worked by Medicaid recipients would be unchanged, and state costs would increase.” A big factor is that work requirements create administrative and reporting barriers that lead to lower Medicaid enrollment.

The vice presidential debate may highlight key issues for “working class” Americans but may or may not touch on Medicaid, an issue that has been largely absent from the campaign. If Medicaid and work requirements do come up, it is an important reminder that, as with most health policy choices, there are trade-offs. But even though the focus may be on “work requirements,” the trade-offs are not about increased work, but about the number of working people who would have access to Medicaid coverage.