Unclaiming and Reblaming: Medicaid Work Requirements and the Transformation of Health Care Access for the Working Poor

Julie Novkov

This Essay will look at the imposition of Medicaid work requirements in states that expanded access to Medicaid under the Affordable Care Act (“ACA” or “the Act”). Poverty policy scholars have roundly criticized this development, which began in 2018 after the Trump Administration indicated its interest in receiving proposals for new programs. This policy development underlines and links several long-standing themes: Access to affordable health care is a privilege rather than a right; the poor can and should be divided into deserving and undeserving categories; benefits provided to the poor need to be policed strictly to prevent fraud; and able-bodied adults should not be given any kind of support or benefit unless they are working for wages or actively seeking wage labor.

But of equal importance, and inextricably intertwined with the policy change, is the implementation of work requirements through the use of automated systems. This Essay will argue that understanding the shift to automation contributes to a stronger critique of work requirements. As an integral part of work requirements, automation reverses the conventional structural process of naming, blaming, and claiming while simultaneously creating injuries. Automated systems remove human agents from decisionmaking, reconfiguring law's violence in ways that sublimate and mask state actors' intent by shattering it into numerous individual pieces that cannot be tied to cognizable wrongdoers. Procedural due process becomes completely attenuated, utterly detached from what is happening to people. The victims of these failures, as the only visible agents remaining, are left to carry the blame, and breakdowns and problems become an anticipated and expected part of the process.