As the federal government is poised to end the longest shutdown in history, it is noteworthy that Rep. Erin Houcin (R-Ind.) recently claimed that reinstating Medicaid work requirements would restore the “dignity of work.”
But there’s nothing dignified about an economy where wages stagnate, workplaces are unsafe, and nearly 29 million adults can’t afford or access quality healthcare.
If dignity in work is disappearing, it’s not because people have stopped working. It’s because the country’s leaders have stopped valuing workers, prioritizing profits over people.
As university faculty in public health researching what harms working class people, it is apparent in both data and anecdotes that the dignity crisis isn’t moral. It’s material.
For decades, politicians in this country have preached about the “dignity of work” while undermining the very conditions that make work dignified. Real wages have been flat for half a century.
According to the Economic Policy Institute, worker productivity grew by more than 87% between 1979 and 2025, while hourly pay increased less than 33% during the same time. The federal minimum wage has been stuck at $7.25 since 2009, the longest freeze in history.
According to Massachusetts Institute of Technology’s Living Wage Calculator, a single adult with one child needs to earn at least $35 an hour to meet basic needs nationally. That’s nearly five times the federal minimum wage.
More than 39 million workers (nearly 1 in 4 workers) are paid less than $17 an hour. The typical worker now needs more than 52 weeks of income to afford 52 weeks of expenses. What Americans need isn’t a lecture about the dignity of work — it’s a commitment to a living wage.
Work is a social determinant of health. And in the United States, work is making people sick.
Public health research is clear: where people work, the stability of employment, working conditions, the wages earned, and the stress endured all influence the health they experience. International experts call for advancing opportunities for decent work.
Yet many jobs in America harm health. Burnout is at a 10-year high. Nearly half of low-wage workers have no paid sick leave. Long hours, erratic schedules, and job insecurity are linked to higher rates of hypertension, anxiety, and injury. These are not personal failings. They are policy failures that turn work itself into a health risk.
Workplace protections have been gutted, too.
OSHA, the federal agency, established by Republican President Richard Nixon in 1970 in response to public demands to keep workers safe, has been defunded and understaffed for decades.
In January of this year, the Nullify the Occupational Safety and Health Administration Act (NOSHA) calls for the complete abolition of OSHA and repeal of the 1970 law that created it. While the bill has almost no chance of becoming law, it reveals the ideological direction: federal worker-safety oversight is on the chopping block.
That is not “dignity in work.” It is abandonment.
Union membership is the most reliable pathway to better wages and safer workplaces, but has fallen to less than 10% of workers, even as public support for unions is near record highs. Meanwhile, the federal workforce has been under concerted union-busting pressure. More than one million federal employees lost collective bargaining rights through executive orders this year.
Work requirements tied to Medicaid are not about work. They’re about control.
At the heart of these debates lies a question of deservedness — who is deemed worthy of health, safety, and stability. Public policy too often answers that question through labor, implying that only those who can work, or can prove they are working, deserve care. It’s a moral logic that punishes vulnerability instead of protecting it.
Medicaid work requirements don’t create jobs or improve health. They create paperwork and strip coverage. The vast majority of “able-bodied adults” on Medicaid already work. Among adults under the age of 65 on Medicaid who don’t receive disability benefits under Social Security and aren’t covered by Medicare, 92% are working full or part-time.
In Arkansas’s failed Medicaid work requirement pilot, more than 18,000 people lost healthcare coverage within months. Most were already working but couldn’t navigate an online reporting system or had fluctuating hours. A formal analysis found no increase in employment. Instead, the policy pushed people out of coverage and into instability—the opposite of what improves health or readiness to work.
Losing Medicaid often reduces people’s ability to work. Uninsured individuals are less likely to access preventive care, more likely to have untreated chronic conditions, and more likely to fall into medical debt. That’s not restoring dignity. It’s weaponizing it.
If policymakers truly cared about the dignity of work, they would make it healthy and sustainable. That means raising the minimum wage, funding OSHA, guaranteeing paid family and medical leave, enforcing fair-scheduling laws, and protecting the right to organize. It means ensuring that having a job no longer comes at the cost of your health, your family, or your life expectancy.
Healthcare must be a foundation of work, not a reward for it. A healthy workforce is a productive one. But when healthcare depends on your job — or worse, your ability to report every hour worked — illness becomes a disqualifier and unemployment becomes a sentence.
The dignity of work must mean that all labor is respected and protected. Healthcare is a human right. Poor people do not have to prove their worthiness to receive care.
There is not a work ethic problem in America. There is a leadership problem where productivity and profits are valued over people.
And until that is fixed, no amount of moralizing about Medicaid will make work dignified again.