We’ve known for decades what actually works. In Montana, a pilot program offered voluntary job supports for Medicaid recipients—transit help, childcare, résumé coaching. Enrollment rose by six percentage points. Not because people were forced—but because they were equipped.
The same pattern holds globally. In India, Ethiopia, and Argentina, large-scale public employment programs didn’t just put people to work. They built roads, childcare centers, wells. Skills developed. Incomes rose. A wage—not a warning letter—was the foundation.
“These programs didn’t assume laziness. They assumed exclusion.”
Contrast that with what Pathways became: a maze of documentation, deadlines, and disappearing support. The people who fall through it aren’t shirking work—they’re already doing it. They’re managing symptoms, juggling schedules, parenting without backup. The policy assumes they’re lying. The experience teaches them they’re alone.
Luke Seaborn still works with his hands. He built a parts table out of scrap pine and bolted it to the shop wall last winter. It’s held up through two engine rebuilds.
The state never told him how to appeal. His therapy stopped. His lower back stiffens by noon.
“I’ve learned to expect less,” he says now. Not bitter. Just used to it.”
A decade ago, one policy analyst described the safety net as “a basic floor of protection.” But when the floor is made of conditions, deadlines, and cracks wide enough to fall through—what’s left?
The next form should start by asking what people need—not what they failed to do.
Bibliography
1. Sommers, Benjamin D., et al. “Medicaid Work Requirements — Results from the First Year in Arkansas.” New England Journal of Medicine 381, no.11 (September 2019): 1073–82. https://doi.org/10.1056/NEJMsr1901772.
2. Hahn, Heather, et al. “Work Requirements in Safety Net Programs: Lessons from the Past.” Urban Institute, February 2020. https://www.urban.org/research/publication/work-requirements-safety-net-programs.
3. Georgia Department of Community Health. “Pathways to Coverage: Overview and Implementation.” Updated May 2025. https://dch.georgia.gov.
4. Center on Budget and Policy Priorities. “Georgia’s Medicaid Work Requirement Is Failing.” June 2025. https://cbpp.org/research/health/georgia-pathways.
5. U.S. Department of Agriculture. “SNAP Work Requirements.” Food and Nutrition Service, Updated April 2024. https://www.fns.usda.gov/snap/work-requirements.
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8. Kaiser Family Foundation. “Medicaid Work Requirements: Who’s Affected and What We Know from State Data.” March 2024. https://www.kff.org.
9. Hopkins, Harry. Speeches and Papers, 1935–1936. Quoted in William E. Leuchtenburg, Franklin D. Roosevelt and the New Deal: 1932–1940. New York: Harper & Row, 1963.
10. Church, Tea. Personal testimony submitted to House Committee on Agriculture, April 2025.
11. Bryant, Jasmine. Interview by local press in Fulton County, Georgia, May 2025.
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13. World Bank. “Public Works as a Safety Net: Design and Implementation.” Social Protection Discussion Paper No. 1002, January 2021.