September 1, 2026
The Honorable Darin LaHood
Chair
U.S. House Committee on Ways and Means
Subcommittee on Work and Welfare
Washington, DC 20515
The Honorable Danny Davis
Ranking Member
U.S. House Committee on Ways and Means
Subcommittee on Work and Welfare
Washington, DC 20515
Dear Chairman LaHood, Ranking Member Davis, and Members of the Subcommittee,
On behalf of National Taxpayers Union, we commend you for holding a hearing commemorating the 30th anniversary of the bipartisan welfare reforms enacted in the Personal Responsibility and Work Opportunity Reconciliation Act of 1996. The work requirements created by this legislation strengthened the social safety net by refocusing government assistance on vulnerable members of society while encouraging able-bodied adults to seek out employment and self-sufficiency. Three decades later, the principles underlying this pro-taxpayer reform remain as relevant as ever as the federal government and the states begin implementing the community engagement requirements for Medicaid enacted by the Working Families Tax Cuts.
Obamacare’s expansion of Medicaid eligibility to include able-bodied adults earning up to 138% of the federal poverty level has resulted in explosive spending growth while shifting resources away from truly vulnerable recipients, such as children living in poverty. By offering states a significantly higher federal matching rate for the expansion population than for traditional beneficiaries, Obamacare created a strong incentive for state Medicaid agencies to expand enrollment among able-bodied adults. Fueled by these perverse incentives, between 2014 and 2024, Medicaid expenditures surged by 88%.
Against this backdrop, targeted work requirements are necessary to protect access to care for Medicaid’s traditional enrollees, such as individuals with disabilities, low-income seniors and children. Getting healthy, working-age adults off government welfare rolls and into the labor force, where they can access employer-sponsored health insurance, empowers workers, saves taxpayer dollars and frees up scarce federal resources for Medicaid’s truly vulnerable recipients. The Congressional Budget Office estimates that these work requirements alone will save taxpayers $326 billion over ten years.
Beyond the benefits for taxpayers and federal health programs, the community engagement requirements for able-bodied Medicaid recipients—which can be satisfied with just 20 hours per week of work, study or volunteering—will yield profound health benefits. Long-term unemployment is associated with higher rates of cardiovascular disease and depression, and one study published in the journal Epidemiology and Psychiatric Sciences even recommended work as a “critical mental health intervention.”
These findings are especially relevant for Medicaid enrollees. A study by the Foundation for Government Accountability notes that 62% of able-bodied adults on Medicaid reported no earned income. Moreover, survey data show that many unemployed Medicaid recipients dedicate significantly more hours to passive screen time than productive activities like studying or volunteering. What makes this detachment from work especially concerning is that it persists in an economy with a subdued labor force participation rate. As of July 2026, this figure stood at 61.4%, which is more than 5% lower than its peak in 2000.
Work requirements in welfare programs have a strong track record. By imposing modest work requirements on certain recipients of cash assistance and food stamps, the 1996 welfare reforms contributed to higher employment, particularly among low-income single mothers. Plummeting welfare caseloads in subsequent years, along with higher tax receipts from increased labor force participation, strengthened the federal government’s fiscal standing.
The success of Medicaid’s community engagement requirements will depend on how thoroughly they are implemented. Past experience with the work requirements established by the 1996 law has demonstrated that administrative loopholes and inconsistent enforcement can substantially undermine congressional intent. For example, states have routinely exploited geographic-area waivers to exempt local beneficiaries from federal mandates that require able-bodied adults without dependents to work, study, or volunteer at least part-time to remain enrolled in the Supplemental Assistance Nutrition Program (SNAP). As such, we urge the Committee to focus on ensuring that the community engagement requirements in Medicaid are thoroughly implemented by the states.
Sincerely,
Alexander Ciccone
Policy and Government Affairs Manager
National Taxpayers Union