Republicans in half a dozen states have a request for a second Trump administration: Require low-income adults to work for free government health care.

In places like Idaho, Missouri and South Dakota, GOP officials are laying the groundwork to substantially overhaul their health safety-net programs. Their plans, if approved by a Trump White House, could cut hundreds of thousands of people from a program that conservatives have long complained is bloated — but the move could also save states and the federal government billions of dollars.

“Here in South Dakota, we value hard work. For those who are able-bodied, we want to incentivize work, not government entitlement,” said South Dakota Senate Majority Leader Casey Crabtree, a Republican. “We want to be in a position, should there be a change [in the White House] — and hopefully there’s change — that we can implement that.”

The Trump administration authorized 13 states’ work requirements, which tied Medicaid to employment, though only Arkansas’ got off the ground. More than 18,000 people were removed from the rolls in that state before a U.S. District Court judge blocked the program in 2019 and the Biden administration revoked states’ approvals, effectively stifling efforts nationwide.

But the Supreme Court, which never heard the issue, has since added another conservative jurist, and that gives some Republicans hope that their plan, if approved in a second Trump term, would prevail.

“I do think this Supreme Court is more favorable to uphold” work requirements, said Ohio state Sen. Steve Huffman, the Republican chair of the Senate health committee.

The Trump campaign did not respond to a request for comment, and the former president has not discussed the policy on the trail.

Still, work........

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