The reconciliation bill passed by the United States House of Representatives imposes community engagement requirements for childless non-disabled Medicaid recipients age 19–64, starting in 2027. The requirement can be met by spending 80 hours in at least some months either working, going to school, participating in a work program, or doing community service. In a previous analysis, I found that between 40 percent and 56 percent of childless non-disabled Medicaid recipients age 19–64 would not have been in compliance in 2022.

Since a large share of Medicaid recipients covered by community engagement requirements would be out of compliance, a relevant question is how they currently spend their time, especially among those who are not working. Do they currently spend a significant amount of time in less productive activities which could be freed up to increase their time working or otherwise engaging with the community? In particular, do they spend a lot of time playing video games or watching television as some political leaders allege? Or would increased time complying with the community engagement requirement take time away from looking for work or caring for family members?

I answer these questions using the American Time Use Survey (ATUS), a nationally representative survey used extensively in government and academic research, which provides detailed information on the amount of time Americans spend in various activities during a given day. I determine whether individuals were Medicaid recipients by linking the ATUS with the Current Population Survey Annual Social and Economic Supplement (CPS ASEC), which asks about health insurance coverage two to five months before they received the time use survey. I pool multiple years of these surveys, due to the relatively small sample that receives both the ATUS and CPS ASEC in a given year.

In the figure below, I report the time use of childless non-disabled adults age 19–64 who are not in school. I estimate the mean number of hours per day spent engaging in various activities: working; looking for work; volunteering and civic obligations; watching television and playing video games; other socializing, relaxing and leisure; housework and errands; caring for others; eating and drinking; sleeping; and other activities. The first two bars focus on Medicaid recipients, and the second two bars focus on non-Medicaid recipients. I also distinguish between individuals who report being employed and individuals who report being not employed, at the time of the survey about their time use.

For Medicaid recipients who do not report working, the most common activity after sleeping is watching television and playing video games. They spend 4.2 hours per day watching television and playing video games, or 125 hours during a 30-day month. That is more than 50 percent higher than the 80 hours they would be required to work or otherwise engage with the community during at least some months under the reconciliation bill. They spend on average 6.1 hours per day, or 184 hours per month on all socializing, relaxing and leisure activities (including television and video games). In the average day they spend about 0.36 hours (i.e., 22 minutes) looking for work, 4.0 hours doing housework and errands, and 0.47 hours (i.e., 28 minutes) caring for others.

For Medicaid recipients who report working, the most common activity after sleeping is work. They work an average of 4.2 hours per day, or 126 hours per month, enough for the average working Medicaid recipient to comply with the community engagement requirement. Working Medicaid recipients spend a lower 2.7 hours per day watching television and playing video games, and a total of 4.5 hours on all socializing, relaxing and leisure activities.

The two rightmost columns of the figure report the same breakdown of time use for the same population of childless non-disabled adults age 19–64, except that these individuals were not enrolled in Medicaid. The average time use of non-workers who do not receive Medicaid is similar to those who do receive Medicaid. Workers who do not receive Medicaid spend a similar amount of time watching television and playing video games as Medicaid recipients, while working about 1.2 more hours per day. Their greater work hours are not surprising given that working more hours increases earnings and reduces the chance that an individual will still be eligible for Medicaid.

Time use patterns alone are not sufficient to determine whether community engagement requirements are a good idea. Other factors that policymakers should consider include, for example, impacts on work and other community engagement, government spending, costs to hospitals, and the health and mortality risks of current Medicaid recipients. But understanding how Medicaid recipients who will be subject to the new community engagement requirements spend their time provides a picture of how they might need to reallocate their time if they start working or more frequently engaging with the community.