Ronald Reagan and his fellow Republicans once invoked what they referred to as “welfare queens” as they made the case for reining in social spending in the 1970s and 1980s, painting a picture of unscrupulous women bilking the system to finance a sumptuous lifestyle.
Now as they try to justify cuts to Medicaid, congressional Republicans are focused on a different deadbeat poster child: the shiftless male video gamer who lazes around the house attached to his console while getting free health care that should go to more deserving people.
The imagery has changed, but the political tactic from the G.O.P. remains the same. By making broad generalizations about the types of people who could inappropriately benefit from federal benefits, they make the idea of cutting back seem virtuous rather than stingy.
With a new, restrictive work requirement for Medicaid and other cost-cutting measures emerging as main points of contention in the political debate over their sweeping domestic policy bill, Republicans have sought to play down the potential fallout for Americans who rely on the health care program for the poor. They say no one who truly merits help will lose benefits.
To bolster their case, they assert that ridding the Medicaid rolls of slackers and undocumented immigrants who should not be getting taxpayer help will shave off billions of dollars without touching benefits for those in need. Their message is that the necessary savings can be achieved by going after the old standbys of waste, fraud and abuse.
“You don’t want able-bodied workers on a program that is intended, for example, for single mothers with two small children who is just trying to make it,” Speaker Mike Johnson said on CNN in February as he began laying the groundwork for the Medicaid cuts. “That’s what Medicaid is for, not for 29-year-old males sitting on their couches playing video games.”
Representative Lauren Boebert, Republican of Colorado, piled on to the perceived couch potato community.
“If you are able to work in America, well then you should not be sitting at home playing video games and collecting a check,” she said last month after meeting with President Trump and hearing his pitch for the legislation.
Other Republicans, Democrats and data analysts say that most Medicaid beneficiaries are already working. They note that even if a glut of loafing gamers did exist, cutting them off from government-provided insurance won’t save much money, since they don’t use much health care.
“They’re not on Medicaid because they are malingerers,” Senator Josh Hawley, Republican of Missouri, said about his 1.3 million constituents currently on Medicaid. “They are on Medicaid because they can’t afford private health insurance.”
But Republican proponents of cuts say their argument was underscored by a recent analysis from the American Enterprise Institute. Applying the American Time Use Survey and the Current Population Survey, the report estimated that able-bodied Medicaid recipients who don’t work spent about 4.2 hours a day watching television or playing video games, their second most common activity after sleeping. Working Medicaid recipients, it said, spent about 2.7 hours watching TV or gaming.
The speaker’s office said the findings substantiated Mr. Johnson’s point that some beneficiaries were gaming the system as they gamed at home.
“The next time a Democrat makes false claims about ‘Medicaid cuts,’ just remember that what they’re really saying is they want illegal aliens and able-bodied adults playing video games at home to continue stealing resources from those who need it,” the speaker’s office said in a news release
Yet a new analysis from the Brookings Institution questioned the potential impact of the new House-approved work rule, which would require childless adults without physical limitations to show they had worked, volunteered or gone to school for at least 80 hours in the month before enrolling in Medicaid.
Even if the new requirements now under review in the Senate did catch some idle gamers, the savings might not prove to be that great, the analysis said. The 4.3 million people the study said were on Medicaid with no limits on activity recorded the lowest average Medicaid spending, while 40 percent did not use medical services at all. The authors said their data showed that just 300,000 beneficiaries reported that they didn’t work simply because they didn’t want a job.
“Speaker Johnson’s archetypal young men who hang out in basements playing video games are not as common as he may imagine, and just don’t use a lot of health care services,” said the Brookings report, written by Sherry Glied and Dong Ding. “Disenrolling this group would generate only modest federal savings, far less than needed to offset a significant share of the bill’s tax cuts,” they added.
Democrats say Republicans are well aware that millions of Medicaid beneficiaries are not whiling away the hours at home playing video games while they eagerly take advantage of a program where eligibility is tied to low income. They say Republicans are misrepresenting the situation in pursuit of savings to offset tax cuts in their legislation.
“They are just desperate for money and they know there’s a lot of money to be saved by pulling people off welfare,” said Senator Brian Schatz, Democrat of Hawaii. “And so they have to imagine an unworthy person.”
Senator Richard Blumenthal, Democrat of Connecticut, said Republicans wanted to justify their Medicaid cuts by stigmatizing “health care as a handout, when it should be something that enables the whole society to be more productive.”
“I think we are descending into the old ‘welfare queen’ demagoguery, and I think it is a disservice,” he said.
When Reagan ran for president in 1976, he peppered campaign speeches with the anecdote of a Chicago woman who had found a way to bilk the welfare system through the use of aliases and other fraud. The claim that the system was rife with corruption was meant to stir anger and resentment among voters who worked for a living.
Though suggestions of widespread cases of people living a luxurious lifestyle on welfare were debunked from the start, the impression has persisted for decades and surfaces in political and policy fights from time to time. When Congress enhanced unemployment benefits during the Covid pandemic, conservatives balked, saying the extra pay would keep those already disinclined to work at home.
Mr. Johnson and others have accused able-bodied unemployed Americans of “cheating” by receiving Medicaid coverage when they could work, even though the expansion of Medicaid in many states under the Affordable Care Act has made it permissible to obtain coverage without working as long as low-income guidelines are met.
“If you are able to work and you refuse to do so, you are defrauding the system,” Mr. Johnson said in late May on CBS’s “Face the Nation.” He said that there was a “moral component” to the Republican push to impose work requirements on Medicaid recipients and that it would provide dignity to those pushed into the work force.
The Brookings analysis said that many of those who don’t hold a job would probably be exempt from new requirements because of reasons such as caring for a family member or other factors. It predicted that the effort would produce unintended consequences such as discouraging those who need Medicaid from qualifying for help because of new paperwork requirements.
“Prior efforts to surgically separate the meritoriously enrolled from the slackers have proved both ineffective and very administratively costly,” the report said. “Medicaid work requirements just don’t work in the way their proponents promise they do.”
Robert Jimison contributed reporting.
Carl Hulse is the chief Washington correspondent for The Times, primarily writing about Congress and national political races and issues. He has nearly four decades of experience reporting in the nation’s capital.
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