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There’s no data to indicate that any significant portion of Medicaid recipients who are capable of working are failing to do so. Conversely, there are reams of data indicating that Medicaid work requirements don’t work; that is, they don’t spur otherwise nonworking recipients to get jobs. Where they have been tried, their primary impact is to spur bureaucratic malaise and the improper expulsion of eligible Medicaid recipients from a health care system they need.

Those unworkable work requirements are also expensive for the states that administer them, as Missouri is learning the hard way. The state itself now estimates that the Trump administration’s misnamed “Big Beautiful Bill� will cost Missouri almost $70 million next year in new expenses related to the new work requirements under the bill.

That’s on top of the inevitable human cost, as an estimated 161,000 vulnerable Missourians — roughly one of every eight Missourians currently covered by Medicaid — lose that coverage.

That’s not to say anywhere near that many Missouri Medicaid recipients are able-bodied yet refusing to work. An analysis this year by , the nonprofit health advocacy organization, found that 92% of Medicaid recipients nationally are either working already or would be exempt from the work requirements because of disability, school attendance or other factors.

That shouldn’t be surprising, given that Medicaid doesn’t provide cash to recipients, but rather directly pays the medical professionals to provide their health care. It’s not like a Medicaid recipient can use the program to buy groceries or pay rent. Most Medicaid recipients who can work do so for the same reason the rest of us do: to live.

Yet the effort to get at that relative sliver of able-bodied Missouri Medicaid recipients who aren’t working will almost certainly end up expelling far more recipients than that from the system. That was the experience of Arkansas’ short-lived 2018 experiment with Medicaid work requirements: Thousands of eligible recipients lost their coverage because they couldn’t navigate the bureaucratic process of proving their employment.

If that sounds unlikely, remember that the working poor tend to have jobs in shifting and unstable industries such as manual labor or food service. They tend to change jobs more often because of layoffs or attempts at better pay, which will mean risking Medicaid coverage loss each time they’re between jobs.

Low-income Americans also don’t always have reliable access to phone and internet services necessary to navigate work-verification requirements in even a well-run Medicaid system — and Missouri’s system is already a mess, with slow application processing and average phone wait times of almost an hour.

Making that lumbering bureaucracy even more lumbering with a work-verification process will necessitate a complete overhaul of Missouri’s Medicaid system. As the Post-Dispatch’s Kurt Erickson reports, budget documents from the Missouri Department of Social Services indicate that that overhaul and related expenses for instituting the work requirements will cost the state about $67 million next year.

While states are responsible for administering the Medicaid system to their residents, the federal government pays for the lion’s share of the actual medical coverage. That means that even as Missouri pays millions more to create and operate a work-verification system that will thin out the state’s Medicaid rolls, the savings from that reduced coverage will flow not primarily back to the state, but to the federal government.

Which was the whole point of adding work requirements in the first place: Congressional Republicans, determined to extend tax cuts for the rich, decided to help pay for it by trimming health care for the poor. And this simplistic solution to the mostly nonexistent problem of nonworking Medicaid recipients was the most politically palatable way to do it.

An analysis by the estimates that these Medicaid cuts alone could result in more than 15,000 preventable deaths annually nationwide due to lack of medical treatment. As Missouri’s state government pays for this gift to the rich with public dollars, some of our state’s most vulnerable residents will pay for it with their health and possibly their lives.