Beginning in 2027, many adults in nearly every state will, for the first time, have to demonstrate that they are working, volunteering, or in school in order to keep their Medicaid coverage. The One Big Beautiful Bill Act, signed into law in July 2025, made these “community engagement” requirements national. Yet the most consequential detail is easily overlooked: the majority of those projected to lose coverage will not be ineligible. Instead, they will be tripped up by a myriad of complex bureaucratic barriers.
Scholars refer to these hurdles as administrative burdens, the learning, compliance, and psychological costs that individuals encounter in their interactions with government. A growing body of research has made clear that such burdens are rarely accidental. Indeed, they are often deliberate policy tools. And while they are less transparent, they nonetheless depend on public support to be enacted and sustained, just like any policy choice. This raises a straightforward question: when is the public willing to tolerate these burdens, and for whom? Put differently, what shapes Americans’ burden tolerance?
To examine this question, I fielded a survey of 4,177 Americans that contained an experiment. Each respondent read about four women applying for Medicaid (a woman with disabilities, a single mother, an able-bodied woman who had been out of work for more than a year, and a woman struggling with opioid addiction) and decided whether each should be allowed to apply online or required to apply in person. The vignettes also relied on racially and ethnically identifiable names that signaled whether each woman was White, Black, Hispanic, or Asian.
Two findings stood out. First, life circumstances drove nearly all findings. Respondents were most willing to ease the way for the woman with disabilities and the single mother, and least willing for the able-bodied unemployed woman and the woman with addiction. Indeed, respondents were frequently unwilling to extend the latter two any relief at all. Second, race and ethnicity barely registered. The beneficiary’s race or ethnicity had almost no effect on respondents’ choices. In short, the effect of life circumstances consistently overshadowed that of race and ethnicity. Importantly, this pattern held across liberals and conservatives alike, and among respondents high and low in racial resentment.
These patterns are more than an academic curiosity and have real policy implications. The new work requirements take direct aim at precisely the group toward which the public expresses the least generosity: “able-bodied” adults who are not working. The findings are therefore consistent with a political environment in which such burdens are unlikely to encounter much public resistance. This is because they are, at least in the political discourse, targeted at individuals whom the public has, in effect, deemed less deserving of assistance. Of course, given what we know about the effect of administrative burdens, the collateral damage will ultimately be much larger and affect both the “deserving” and “undeserving”.
For researchers, the findings open at least as many questions as they answer. Why does race wash out here? Is this a genuine null, or an artifact of how race is cued in a survey setting? Do these patterns extend to other programs and other types of burdens, or is Medicaid distinctive in this regard? And as states implement work requirements over the next two years, scholars are presented with a rare natural experiment: an opportunity to observe whether attitudes about who deserves relief shift once these burdens become tangible.
The politics of paperwork are opaque, but they are not neutral. As this latest round of requirements takes hold, it is worth remembering that the public already holds firm views about whose path to assistance should be smoothed — and whose should not. As such, these seemingly mundane administrative choices remain an important arena in the ongoing struggle over the reach of the American safety net.
Read the original article in Policy Studies Journal:
Haeder, Simon F. (2026). “Assessing the Effect of Deservingness Cues on Tolerance for Administrative Burdens” Policy Studies Journal 54(1): e70043. https://doi.org/10.1111/psj.70043.
About the Article’s Author(s)
Simon F. Haeder, PhD, MPA, is an associate professor in the Division of Health Services Management and Policy at The Ohio State University College of Public Health. His research examines how people gain — or lose — access to health and health-protective services, with particular attention to administrative burden, provider networks and network adequacy, vaccination policy, school-based health services, and the federal regulatory process. His work has appeared in Health Affairs, JAMA, the American Political Science Review, and the Journal of Health Politics, Policy and Law, among others. He also writes frequently for general audiences, translating health policy research into accessible insights for policymakers and the public.
Policy Studies Journal Blog 