COVID and the Great Retrenchment

I. Introduction

The past six years have seen at least two dramatic and stunning shifts in federal health and benefits policy. First, during the depths of the COVID pandemic, the government dramatically expanded a variety of public benefits, including support for income, food, housing, and health care. Many of these benefits expansions were framed in explicitly universalistic terms (covering everyone, regardless of their wealth, prior income, or other indicia of need). Many others broadened the coverage of existing targeted benefits programs in ways that moved towards universalism. These expansions had incredibly positive effects, and those who received the newly expanded benefits were largely satisfied with them. But the expansions were quickly followed by the second dramatic and stunning shift: After a relatively short time, Congress rolled back nearly all of the benefits expansion. As three leading commentators put it, “The COVID-19 pandemic seemed to herald lasting reform of U.S. safety-net programs,” but “the permanent change that many predicted never materialized.”^[1]

But it’s even worse than that. The immediate pullback from COVID-era expansions set the stage for even more significant retrenchments in the second Trump Administration. Where in 2023 the United States came the closest it has ever come to universal health care—with a record-low uninsured rate of 7.7%^[2]—Trump Administration actions now threaten to wipe out essentially all of the gains we have made since adoption of the Affordable Care Act (ACA).^[3] And the Trump Administration’s reconciliation legislation, the One Big Beautiful Bill Act (OBBBA),^[4] seems to have, in particular, eliminated the aspiration that health care is or should be a universal right. The OBBBA’s Medicaid provisions rest on the premise that health care is something that people should earn by their individual contributions to society and the economy—the precise opposite of the incipient or immanent universalism of the COVID-era programs, and of the avowed ultimate goal that informed the drafting and implementation of the ACA.^[5]

From Medicare and Medicaid, through the ACA, to the COVID expansions, we had been moving toward a place where health care was a right. Now we seem to be returning to the precepts of the English Poor Laws. Those laws were based on the principle that basic health and subsistence must be withheld from those who do not contribute to societal productivity—and that we must closely regulate those who receive public assistance to ensure that they contribute.^[6] That is a change that does not just roll back recent expansions. Rather, it threatens core premises that have informed health and other benefits policy since the Great Society.

That is not what many drafters of the COVID-era expansions thought would happen. Rather, they thought people would come to rely on and appreciate the new benefits. As a result, they believed, people would resist any efforts to roll those new benefits back—and Congress, out of fear of a popular backlash, would extend the expansions and eventually make them permanent.^[7] These drafters did not come to those ideas unthinkingly. Those ideas have informed the domestic policy priorities of the Democratic Party for years now. They explicitly draw on a long line of work in political science that demonstrated—or seemed to demonstrate—the durability of benefits expansions.^[8] (Crucially, that work was qualified in ways that policymakers did not always appreciate^[9]—but I am getting ahead of myself.) Yet the Biden Administration could not muster the votes in Congress to make the COVID expansions permanent. And when the public seemed to tire of the COVID response, and the Republicans took back both chambers of Congress in the 2022 midterms, the Biden Administration acquiesced in rolling those expansions back significantly.^[10] The durability-of-benefits-expansions theory did not predict such a quick reversal. Nor did it predict the massive retrenchment, eroding decades of progress, that built on the COVID rollbacks just a couple of years later.

I had a front-row seat to these successive reversals. From January 2021 to December 2024, I worked in senior positions in the parts of the Executive Branch that were responsible for drafting, advocating for, and implementing the changes in benefits policy, first as General Counsel to the Office of Management and Budget and then as General Counsel to the Department of Health and Human Services (HHS). I saw how we dramatically expanded cash and health benefits, how we celebrated the record-low uninsurance rate, and how, as political support for these programs weakened, we let those great wins slip away. That experience left me looking for answers—answers regarding why the political experts who thought that benefits expansions would be durable were so wrong, and answers regarding what lessons advocates of universal benefits might take from that experience.

This Article takes an initial stab at those questions. From the COVID experience, we learned that universal benefits are not as politically durable as many in Democratic Party policy circles believe, particularly when those benefits are in their early, vulnerable years.^[11] And we saw clearly that because universal (or more universal) benefits tend to give workers more bargaining power vis-à-vis employers, employers have a strong political incentive to fight against expansion that moves towards generosity and universalism. Expanded COVID-era benefits gave workers an exit option from unsafe, intolerable, or poorly compensated jobs, and many workers took that option (while others merely threatened to do so in an effort to obtain greater concessions from their employers).^[12] Business owners responded with anger and confusion when they saw a challenge to the hierarchy of the workplace. And they understood that they may have only a short time to keep benefits from becoming entrenched—a point the failed efforts to repeal the ACA drove home^[13]—so they fought especially hard to squelch them early on.

Opponents of universal benefits recognized that whether benefits programs are understood as universal (descriptively or normatively) is not a purely objective matter. It is a matter of social meaning—a meaning that can be the subject of political contestation.^[14] When employers saw that the expansion of cash and health benefits programs threatened their bargaining power vis-à-vis their workers, they had a strong interest in describing those programs not as universal protections but as compassionate aid for deserving people going through hard times. They could then argue that allowing the expansions to continue was stretching the programs beyond that purpose and extending benefits to those who were not deserving. Unfortunately, they were so successful that they not only reversed the COVID-era gains but also provided the expressed policy basis for the even broader retrenchment effected by the Trump Administration.^[15]

And this leads to my final point: Those who thought that COVID-era expansions would be durable relied on a particular story that drew on decades of work in political science—that new policies make new politics,^[16] and that new benefits in particular create constituencies for those benefits, who resist rollbacks.^[17] But the COVID experience shows that this story misses some important points. It treats the costs imposed by an expansion of cash or health benefits as diffused (basically just the costs of taxation to pay for the new benefits, spread across the population).^[18] It thus ignores the way that powerful economic actors can see new benefits programs as a particular, focused threat to their economic and workplace hegemony—a view that employers expressed and acted on during the COVID benefits expansion.^[19] The policies-make-politics story thus also ignores the need to build up the political power of those with an interest in defending benefits expansions. Beneficiaries may have an incentive to defend benefits expansions, but the COVID experience raises serious questions about whether those expansions can be durable if we do not first attend to imbalances of political power.^[20]

II. COVID and the Move Toward Universal Benefits

In a moment, I will highlight the key benefits expansions that the federal government adopted during the depths of the COVID pandemic. As I will argue, these expansions moved us in the direction of universalism. But first, I should explain what I mean when I use that term.

A. Universalism

What is universalism? It’s relatively easy to describe as an ideal type. Universal benefits are those to which everyone is entitled. Their opposite would be targeted benefits, to which only people who meet certain criteria are entitled.

But this is just an ideal type. In reality, virtually all benefits provided by the government have some eligibility criteria that limit them to a group narrower than the entire world. (Public libraries may be an exception—but even their circulation privileges are often limited to those who live in the local community.) Consider Social Security Old Age Insurance, which is often understood to be the paradigm case of a universal public benefit.^[21] Even that program is not open to literally everyone. To be eligible, one must work and pay Social Security taxes for a certain number of years in a covered job.^[22] And even some who meet these criteria will be excluded, because, for example, they worked in the United States as unauthorized immigrants.^[23] But we think of Social Security as a universal benefit anyway, because a broad group of people is eligible for it, and perhaps because those people have “earned” it by contributing their taxes to the Social Security system.

Generalizing from that example, I think it’s best to understand universal and targeted benefits not as discrete categories so much as the extremes of a more continuous spectrum or field.^[24] There are two key dimensions of a policy that make it more likely to be understood as universal: (1) the broader the group of people who receive the benefit, the more likely is the benefit to be understood as universal and (2) the fewer behavioral requirements an individual must satisfy to claim and continue receiving the benefit, the more likely is the benefit to be understood as universal.

Universal benefits are often understood to have important positive qualities. They promote a sense of equal “citizenship” or membership in the community—and thus avoid the stigma that might attend to the receipt of benefits.^[25] They avoid the stigmatization that occurs as claimants run the gantlet of an administrative process that decides whether they are “deserving” or “undeserving.”^[26] Correlatively, they encourage agencies to be less stingy in administration—and less inclined to regulate the lives of recipients—because administrators need not fear giving benefits to those who do not “deserve” them.^[27] They avoid placing administrative burden on recipients—a burden that may, as a practical matter, keep even those who are formally entitled to benefits from realistically having access to them.^[28] For the same reasons, they reduce the government’s own administrative costs, ensuring that more of the budget goes to benefits recipients.^[29] They avoid provoking resentment among those who do not get the benefit. And, for these and other reasons, they secure broader political support.^[30]

Crucially, all of these positive qualities turn on societal perceptions of a given benefits program. Because basically all benefits have some limiting eligibility criteria, whether to call a benefit “universal” is a social rather than a purely conceptual judgment. Benefits programs can virtually always be described analytically as universal in some respects and targeted in others. I have argued in previous work that whether a particular program is understood as universal will depend on questions of social meaning.^[31] That social meaning, in turn, is very much the subject of contestation. Those who advocate or oppose particular benefits programs have a strong incentive to try to shape public perceptions of the universalism (or targeting) of those programs.^[32] As we will see, opponents of the COVID-era benefits expansions engaged in just that sort of shaping of perceptions.

B. Examples of Federal Benefits that Moved Toward Universalism During the Pandemic

Congress adopted an array of relief programs during the pandemic. Many did not build on existing social welfare programs but instead sent out obviously short-term grants to states, businesses, or individuals to meet immediate needs. They included the State and Local Fiscal Recovery Fund (SLFRF), a $350 billion program created by the American Rescue Plan Act (ARPA) that gave money to state, local, territorial, and tribal governments to make up for lost revenue and enable them to respond to the pandemic’s impact.^[33] They also included several initiatives, such as the Coronavirus Food Assistance Program,^[34] the Paycheck Protection Program,^[35] and the Provider Relief Fund,^[36] that gave money to businesses and nonprofits to cushion the economic impact of the pandemic. And they included the Emergency Rental Assistance program, which gave grants to states to enable them to assist renters who were displaced by, or at risk of being displaced by, the pandemic.^[37] These emergency relief programs are not my focus here, though they were an important part of the COVID response.

I focus on COVID programs that created individual entitlements. These programs often enhanced prior social welfare entitlements administered by the federal government, and they expanded those existing cash and health care benefits in a way that plausibly moved them toward universalism. In at least some of these cases, many of the Democrats who supported them believed that the temporary expansions would create a politics of entrenchment—that the expanded benefits would prove so popular that it would be politically impossible to retrogress. As I show in the next Part, they were wrong about that. But they were right that the expansions would have significant, positive effects.

1. Child Tax Credit

Perhaps the most remarked-upon example of the federal government’s move toward universal benefits during COVID is the expansion of the Child Tax Credit (CTC). In March 2021, Congress enacted the ARPA, President Biden’s signature COVID relief bill.^[38] Section 9611 of that law added new rules for the CTC in the 2021 tax year.^[39] This provision expanded the credit in several significant ways: While “[p]rior law provided a CTC of up to $2,000 per child ages 16 and younger, with refunds limited to $1,400 per child,” the ARPA provision allowed filers to “claim a CTC of up to $3,600 per child under age 6 and up to $3,000 per child ages 6 to 17.”^[40] Crucially, the new provision made the benefit fully refundable for the first time, which meant that the lowest-income families could now receive the entire credit amount. Although the CTC remained a targeted antipoverty policy, these aspects of the expansion moved it toward universalism.^[41]

The effects were immediate. Child poverty fell by 46%, from 9.7% in the Census Bureau’s Supplemental Poverty Measure in 2020 to 5.2%, the lowest rate ever recorded, in 2021.^[42] Because the credit was now fully refundable, “maximum benefits under the expansion reached the 19 million children whose families’ earnings were too low to receive the full credit under prior income requirements.”^[43] In addition to these impressive top-line results, there is good evidence that the expanded CTC reduced food insufficiency among the families that received it,^[44] and that it did not create a disincentive to work.^[45] The overwhelming majority of recipients “spent their payments on the most basic needs: food, clothing, rent, a mortgage, or utility bills.”^[46]

2. Earned Income Tax Credit

The ARPA also expanded the Earned Income Tax Credit for the 2021 tax year.^[47] In particular, it significantly increased the benefits available to workers without children: raising the maximum benefit, raising the income cap, and making younger workers eligible for the first time.^[48] Like the CTC expansion, the Earned Income Tax Credit expansion seems to have had significant positive effects on the lives of those who received it—in this case, the childless working poor.^[49]

3. Economic Impact Payments

On three occasions during the pandemic, Congress directed the Department of the Treasury to send out “Economic Impact Payments”—generally known as stimulus checks—to those making less than $75,000 for an individual adult or $150,000 per couple.^[50] In the March 2020 Coronavirus Aid, Relief, and Economic Security Act (CARES Act), Congress authorized payments of $1,200 per adult and $500 per child.^[51] In the 2021 omnibus appropriations law, enacted in December 2020, Congress authorized additional payments of $600 per adult and $600 per child.^[52] And the March 2021 ARPA added a third payment of $1,400 per adult and $1,400 per child.^[53] Crucially, Congress did not set a minimum income threshold for these payments, so they were available even to those who earned too little to file a tax return. And the federal government helped to facilitate the receipt of these payments by such individuals—including by sending out payments automatically to individuals who received other federal benefits, rather than waiting for them to ask, and by creating a streamlined means for people to request the payments if they did not receive them automatically.^[54]

The Economic Impact Payments, in practice, looked something like an incipient universal basic income (UBI) program: “the vast majority of Americans received stimulus checks from the federal government.”^[55] And, indeed, many commentators at the time saw them, in conjunction with the other coronavirus relief programs, as at least potentially providing a stepping stone to adoption of UBI in the United States.^[56]

Like the CTC expansion, the Economic Impact Payments had a substantial positive effect. “The first two rounds alone lifted 11.7 million people above the poverty line in 2020, including 3.2 million children, according to the Supplemental Poverty Measure.”^[57] And the payments had a direct impact on food insufficiency.^[58] These results were directly attributable to the elimination of the earnings threshold and the streamlining of the process for claiming and receiving the payments.^[59] In the United States, as elsewhere in the world, “for a brief moment it looked as though basic income advocates were on the right track believing the pandemic had finally pushed open their much-awaited policy window.”^[60]

4. Expanded Unemployment Insurance

Another widely noted COVID initiative significantly expanded unemployment insurance. Even without any legislative changes, the federal unemployment insurance program would have provided some cushion against the COVID-related recession: As people lost jobs, they would be able to claim unemployment insurance benefits, and as economic conditions deteriorated in particular states, the automatic benefits extension provisions in federal law would enable people in those states to claim benefits for additional weeks.^[61] But the pandemic was not an ordinary economic downturn: “[B]y April 2020 the unemployment rate reached its peak at roughly 15 percent—the highest rate observed since data collection began in 1948.”^[62]

Recognizing the seriousness of the situation, Congress significantly expanded the standard program. The CARES Act created the Pandemic Unemployment Assistance program, which entitled individuals to unemployment insurance even if they were self-employed or independent contractors—people who are excluded from traditional unemployment programs, and an increasingly large class of workers in the “gig economy.”^[63] The statute also created Federal Pandemic Unemployment Compensation (FPUC), which added $600 per week to the unemployment checks individuals would otherwise receive.^[64] And it allowed states to extend unemployment assistance for an additional thirteen weeks beyond when an individual’s benefits would otherwise be exhausted.^[65] In the 2021 Consolidated Appropriation Act and the ARPA, Congress extended these provisions through September 2021 (though it reduced the FPUC from $600 to $300 per week).^[66] Although recipients faced significant administrative burdens to claiming the expanded unemployment insurance, and state programs at times found themselves overwhelmed,^[67] the expansion had significant positive effects, “often more than replacing lost wages at the bottom of the earnings distribution . . . and effectively buffering many workers from both the economic and the health consequences of unemployment.”^[68]

5. Paid Family and Medical Leave

In the March 2020 Families First Coronavirus Response Act (FFCRA), Congress adopted a national mandatory paid family and medical leave statute for the first time.^[69] The statute

added a temporary mandate that employers provide paid leave in a variety of circumstances: two weeks’ fully paid leave to employees who are unable to work because they are quarantined or have COVID-19 symptoms, two weeks’ leave at two-thirds of the worker’s normal rate of pay to employees who must care for individuals who are quarantined or have COVID-19 symptoms, and twelve weeks’ leave at two-thirds of the worker’s normal rate of pay to employees who must care for children whose schools or child care providers are closed due to the pandemic.^[70]

It provided the employers with tax credits to pay for the leave taken under its mandate.^[71] Although Congress allowed the mandate to expire at the end of 2020, it continued to provide tax credits to those employers who voluntarily provided paid family and medical leave under FFCRA’s terms.^[72]

The FFCRA paid leave provisions applied to only a narrow slice of employers—those with between fifty and five hundred employees.^[73] As a result, they covered a minority of the workforce.^[74] And only a small fraction of the employers covered by the FFCRA mandate ever claimed the tax credit, even when the mandate was in effect.^[75] Even so, implementation of the leave mandate was associated with a reduction in COVID cases.^[76]

6. Expanded Health Care

Congress also made significant steps to expand access to publicly financed health insurance during the pandemic. The FFCRA gave states extra federal funding for the duration of the federally-declared public health emergency, but only on the condition that the states ensure that those who received Medicaid at the time of the statute’s enactment would remain enrolled in the program.^[77] This “continuous enrollment” provision prevented states from knocking existing beneficiaries off of Medicaid, while continuing to require states to add newly eligible beneficiaries to the rolls. And it had very substantial effects: According to estimates from KFF, around 23 million more people were enrolled in Medicaid and the related Children’s Health Insurance Program (CHIP) by March 2023 than before the pandemic, and the continuous enrollment provision was by far the most significant reason why.^[78]

The ARPA, for its part, provided additional benefits to individuals who receive health insurance on the individual market. The statute significantly enhanced the federal government’s subsidies that defray the costs of premiums charged by plans offered in ACA marketplaces.^[79] Although these enhanced subsidies were originally set to expire after 2022, the Inflation Reduction Act extended them through 2025.^[80] These enhancements made it significantly more affordable for individuals who did not receive health coverage through their employers or a public program to obtain it on the individual market.^[81] According to KFF estimates, the enhanced subsidies “cut premium payments by an estimated 44% ($705 annually) for enrollees receiving” the subsidies.^[82] They coincided with a massive growth in “the number of people with ACA Marketplace coverage”—an increase “from 11.4 million to 21.4 million” between 2020 and mid-2024.^[83] By the end of 2024, HHS was reporting that a record 24 million people were receiving ACA coverage.^[84]

As Chief Justice Roberts noted in his lead opinion in National Federation of Independent Business v. Sebelius, the ACA’s enactment had already begun a shift in the nature of federal health care programs from a series of special provisions for particular groups to something approaching “a comprehensive national plan to provide universal health insurance coverage.”^[85] Taken together, the COVID-era expansions of Medicaid and ACA coverage brought the United States closer than we had ever been to achieving universal health insurance. In the first quarter of 2023, the percentage of uninsured Americans reached a record low of 7.7%.^[86]

III. The Retrenchment

So, the COVID response dramatically expanded existing federal cash and health programs. And it did so in a way that moved toward universalism. It also included no-strings-attached stimulus checks that looked like proof of concept for a UBI program. The results were themselves dramatic. Poverty dropped significantly, childhood poverty was cut in half, people realized significant health benefits, and the United States came within striking distance of universal health care.^[87]

Then, almost as quickly as the expansion began, the federal government pulled back. By mid-2021, the retrenchment was well underway. And by the end of the Biden Administration, nearly all of the benefits expansions had been reversed. The second Trump Administration has gone even further, particularly in health care: It has not just taken back COVID-era protections; it also threatens to return us to pre-ACA insurance levels.^[88] In this Part, I describe the elements of this Great Retrenchment.

A. Expiration of the Child Tax Credit and Earned Income Tax Credit Expansion

When the expanded CTC came up for renewal at the end of 2021, there was reason to believe that it would be extended—and indeed be on a path to permanence. President Biden’s proposed American Families Plan, a part of his broader Build Back Better package, would have extended the CTC expansions through 2025, and would have made permanent the provision making the credit fully refundable.^[89] Other prominent Democrats pushed to make the entire expansion permanent.^[90] These Democrats, who had been crucial to inserting the expanded CTC in the ARPA, had been willing to accept a one-year expansion because they believed that successful implementation would encourage beneficiaries to put pressure on legislators to extend the program.^[91] Professor Jamila Michener explains the thinking:

Aware that the CTC expansion had a one-year time horizon from the very start, supporters hoped that its concrete and significant benefits for a large part of the population would swiftly power its path to permanence. Policy feedback was the (implicit) theory at the heart of such aspirations. The core premise was that the expanded CTC would gain enough mass support to make abandoning it politically untenable.^[92]

But the premise did not hold. Then-Senator Joe Manchin—the pivotal vote in a 50-50 Senate at the time—objected to any extension.^[93] As a result, Congress allowed the expansion of the CTC to expire at the end of 2021.^[94] Congress also allowed the expansion of the Earned Income Tax Credit to expire at the end of that year, despite President Biden’s efforts to extend both programs in his ill-fated Build Back Better bill. These results “shocked” advocates, who, seeing how satisfied beneficiaries were with these new expansions, “really thought that December would come around and, based on the desire of their constituents, this would be made permanent.”^[95]

As with the COVID-era expansions, the results of these retrenchments were dramatic. Child poverty, as assessed by the Census Bureau’s Supplemental Poverty Measure, rocketed up from its all-time low of 5.2% in 2021 to 12.4%—wiping out literally all of the gains the COVID relief bills had generated.^[96] This stark outcome was “due almost entirely to the expiration of the CTC enhancements and other measures included in the President’s COVID-19 response package, including stimulus checks and the expanded Earned Income Tax Credit.”^[97]

Policymakers continue to give attention to expanding the CTC. So far, their efforts have achieved very little. President Trump’s reconciliation bill contained a provision that indexes the CTC to inflation.^[98] Indexing was a long-held goal of the credit’s advocates.^[99] But the new indexing provisions will do little to blunt the impact of the rollback of the COVID-era expansion.^[100] Not only do “the CTC’s income parameters remain unchanged,” but now that the credit is no longer fully refundable, the poorest families will see little benefit.^[101]

B. Ending of the Economic Impact Payments

When Congress enacted the ARPA, lawmakers generally understood that the third round of stimulus checks would be the last round. Some members of Congress pushed for a fourth set of checks, or even for a law that would authorize additional routine payments in the future as part of a package of “automatic stabilizers”—and some commenters argued that the stimulus checks had proven the concept of a UBI.^[102] But concern about inflation meant that a majority of lawmakers lacked appetite for these options.^[103] Although some municipalities continued guaranteed-income experiments they had started during the depths of the pandemic—developments that “fall short of producing anything like a basic income” but “certainly seem to shift policy in a more compatible direction”—“the broad picture remains one of a policy window firmly shut in the face of basic income advocates.”^[104]

C. Expiration and Termination of Unemployment Insurance Expansion

The massive economic downturn, combined with expanded eligibility for benefits, put a major burden on state unemployment insurance systems.^[105] Although individuals who sought benefits continued to face administrative and legal barriers to claiming them,^[106] states also made significant efforts to reduce those barriers, which opened the door to fraud.^[107] It did not take long for dominant political coalitions to unwind the unemployment insurance expansions. Congress let the expansions lapse in September 2021, but by then it was almost a formality—more than half of the states had withdrawn from the expanded program earlier in the year.^[108] And proposals to expand unemployment insurance for future downturns, though earnestly pressed by reformers, had no political traction.^[109]

D. Lapse of the Paid Leave Mandates and Tax Credits

While the unemployment insurance expansions had become deeply unpopular among many politicians by 2021, the provisions for paid family leave—which had been extremely narrow to start with—barely made an impression at all.^[110] Congress could not muster a majority to extend even its narrow-paid family and medical leave mandate into 2021.^[111] And although it extended the tax credits in the 2021 omnibus appropriations bill^[112] and the ARPA,^[113] it let those credits lapse as well.^[114] A brief burst of pressure during the Omicron wave for reinstituting the paid leave policy that Congress had adopted in the early days of COVID went nowhere.^[115]

E. The Medicaid “Unwinding” and Trump Administration Actions

Perhaps aside from the lapse of the CTC and Earned Income Tax Credit extensions, the most significant post-COVID benefits retrenchment was the so-called Medicaid unwinding. In its 2023 consolidated appropriations law, Congress ended the Medicaid continuous enrollment requirement as of April 1, 2023.^[116] States then restarted their process of redetermining eligibility of those enrolled in their Medicaid programs. And the result was to reverse essentially all of the COVID-era increase in the Medicaid rolls.^[117] By the end of the “unwinding,” the KFF estimated, “[o]ver 25 million people were disenrolled,” compared to “over 56 million people [who] had their coverage renewed” during the redetermination process.^[118] About 4 million of those who lost Medicaid coverage in this process were able to shift to ACA marketplace plans.^[119]

Unfortunately, Trump Administration policies are poised to exacerbate the coverage losses.^[120] Because the Administration and Congress could not reach agreement, American Rescue Plan’s enhanced ACA subsidies expired at the end of 2025, and efforts to revive them are effectively dead.^[121] About 90% of those who have ACA marketplace coverage—22 out of 24 million people—received those enhanced subsidies before they expired.^[122] Now that the subsidies have gone away, millions are likely to find their coverage unaffordable.^[123] That number includes some who were thrown off of Medicaid during the post-COVID unwinding, and others who have been on marketplace plans the whole time. And President Trump’s OBBBA includes a number of provisions that the Congressional Budget Office predicts will result in approximately 10 million people losing their health insurance under Medicaid and the ACA.^[124]

Where in 2023 we were as close to universal health care as the United States had ever been, once these changes are implemented, we will live in the opposite world. We will have experienced what health policy scholar Timothy McBride has called “the largest RETRACTION of health insurance coverage ever passed in the U.S.”^[125] And the result will be to “erase almost all (89%) of the reduction in the uninsured since 2013, and raise the uninsured number by 65%.”^[126]

IV. Lessons

The expansion and then contraction of cash and health benefits under COVID presents a puzzle. Political scientists tell us that benefits expansions are sticky—that people get used to the benefits they have, and thus will fight efforts to roll back benefits expansions.^[127] And universal programs are supposed to be especially politically durable.^[128] Yet the COVID-era expansions were quickly rolled back—and that was so even though they made significant moves toward universalism in cash and especially health benefits.

The Democratic leaders who pressed for the various benefits expansions during COVID certainly bet on the durability of those expansions—particularly when they were crafting the ARPA.^[129] In retrospect, they made a very bad bet.^[130] And it is worth exploring what made the bet so bad.

It’s especially worth exploring this question in light of the Trump Administration’s actions in its first year, particularly in health care. Between the enactment of the OBBBA, the failure to extend the Biden Administration’s expansion of ACA marketplace subsidies, and related administrative actions, the Trump Administration has done much more than simply roll back COVID-era health care policies. It has reversed the bulk of the expansion of health insurance availability since the ACA.^[131] Health care had, as a practical matter, been approaching the social, if not juridical, status of a right. But the Trump Administration’s actions have built on the COVID retrenchment to return us to a model that divides the public into “deserving” and “undeserving” segments, with much stingier benefits available to the latter group.^[132] Such a massive regression is not at all what standard theories of policy feedback predict.

In this Part, I draw some lessons from this experience. I highlight a few underappreciated dynamics of the political economy of benefits expansion that seem especially salient here. First, because generous and universal (or more generous and universal) benefits tend to give workers more bargaining power vis-à-vis employers, employers have a strong political incentive to fight against benefits expansion that moves in that direction. And, indeed, there were signs that the expansion of benefits during the COVID pandemic did promise to significantly shift the balance of power between workers and employers. This gave the employers particularly good reason to fight hard to limit the duration of the expanded benefits and to roll them back as soon as possible. Although analysts like Michael Kalecki, Frances Fox Piven, and Richard Cloward have long identified versions of this dynamic, it is not one that has received great emphasis in recent analyses of the entrenchment of public benefits.

Second, whether a policy becomes entrenched or vulnerable to rollback does not depend simply on the material effects of that policy; it depends on the social meaning of that policy. And the social meaning is something that will often be the subject of political contestation. When employers saw that the expansion of cash and health benefits programs threatened their bargaining power vis-à-vis their workers, they had a strong interest in describing those programs not as a step toward universal protections but as compassionate aid for deserving people going through hard times. They could then argue that allowing the expansions to continue was stretching the programs beyond that purpose and extending benefits to those who were not deserving. That is exactly how supporters of the rollback justified their actions. That construction has had a significant continuing effect on health care, providing the express justification for the recent cuts in Medicaid in the OBBBA. The backlash to the COVID-era move towards universalization, particularly in health care, may have helped to entrench a deuniversalized vision of benefits programs.

A. Benefits Expansion, Employer Bargaining Power, and Backlash

Long ago, Frances Fox Piven and Richard Cloward argued that expansion of the welfare state gives workers more bargaining power vis-à-vis employers, because it gives them a stronger exit option.^[133] “If the desperation of the unemployed is moderated by the availability of various benefits,” Piven and Cloward argued, “they will be less eager to take any job on any terms.”^[134] Indeed, many advocates of a UBI argue that their proposed policy is good precisely because it will have the effect of rebalancing the scales of bargaining power between workers and employers. Daniel Raventós puts the point in starkly similar terms to the way Piven and Cloward describe the effects of welfare-state programs generally (though the translation from the Spanish makes the sentence a bit more clunky): “The security of income that the guarantee of Basic Income would offer would put hard-pressed workers in the position of not being obliged to accept a job under any conditions, however bad they might be.”^[135] “One effect of this greater bargaining power for workers,” he says, “would be that capitalists would have to offer pay rises and improved working conditions to make the least appealing and most monotonous jobs more attractive, because nobody would feel obliged to accept them in order to survive.”^[136] A basic income would, in Carole Pateman’s words, “give citizens the freedom not to be employed”^[137]—something that would have “profound consequences for the character of class relations in capitalist society.”^[138]

The COVID benefits expansions seem to have had a very similar effect, though on a smaller scale. By ensuring that workers and their families would not be destitute or lose health care if they were out of work, the enhancements to the CTC, unemployment insurance, and federal health care programs, as well as the stimulus payments, gave workers a meaningful option to exit work they found undesirable. They might have found that work undesirable because it paid too little. They might have found it undesirable because the conditions were intolerable. Or they might have found it undesirable for other reasons. As the pandemic wore on through 2020 and into 2021, commentators increasingly spoke of the “Great Resignation,” in which workers left their jobs in record numbers.^[139] In Professor Miriam Weismann’s words, “[t]he pandemic apparently unleashed a labor sentiment akin to a general labor strike against unwanted job dependency.”^[140] Indeed, workers’ actions in 2021 were not just “akin” to a strike—in many notable cases, workers explicitly went out on strike, as a wave of labor militancy arose.^[141]

Workers seemed, in particular, to be leaving jobs with poor pay or working conditions.^[142] Sometimes, those conditions existed prior to the pandemic. Other times, workers felt alienated or threatened by their employers’ seemingly callous responses to the pandemic.^[143] Either way, they seized the opportunity to leave their jobs. And employers responded by raising wages and improving benefits to entice workers to stay.^[144]

There is reason to believe that the COVID-era benefits expansions played a meaningful role in spurring the Great Resignation, and that the new availability of the exit option enhanced workers’ bargaining power. Quit rates were particularly concentrated in service and retail jobs—comparatively lower-paying positions in which workers were more likely to be dependent on continued employment to pay monthly bills prior to the pandemic.^[145] And “employers in industries with the highest quit rates” seemed especially inclined to improve their wage and benefits packages during the pandemic.^[146] A systematic empirical study by the economists Timothy Richards and Zachariah Rutledge found that the pandemic substantially increased the bargaining power of farm workers and that the expansion of unemployment benefits was likely a significant contributor.^[147]

None of this, of course, can firmly establish that the COVID-era benefits expansions improved worker bargaining power. But there’s a lot of strongly suggestive evidence in that direction. And, crucially, employers themselves seemed to think that it was the benefits expansions that made workers willing to quit—and thus motivated employers to raise pay and improve working conditions to retain them. Just to give a couple of examples: A May 5, 2021, story aired by National Public Radio quoted numerous business owners and managers in the hotel and restaurant industries who complained that the generosity of COVID-era benefits programs made it difficult for them to recruit and retain workers.^[148] Even in mid-2020, well before the COVID vaccines were available, a small business owner (representing the National Federation of Independent Businesses) testified before the Senate Finance Committee that

[w]ith the passage of the CARES Act, the extra $600 a week of unemployment compensation amounts to $15 an hour based on a 40-hour week. That alone pays our lowest paid employee more than they make working a 40-hour week, and all they have to do is sit at home.^[149]

He urged Congress to roll back the unemployment insurance expansions: “May I suggest, as a business owner and someone who, like many other small business owners who have experienced similar situations, do not pay someone more money than they make in a 40-hour work week?”^[150]

It would not be the first time that employers, seeing a threat to their bargaining power, mobilized their political resources to thwart protections for workers. Indeed, as far back as 1943, the Polish economist Michael Kalecki made the case that capital would always engage in this sort of behavior.^[151] He argued in particular that there is a “political business cycle,” in which policies that succeed in promoting full employment trigger a backlash from “business leaders.”^[152] Because “under a regime of permanent full employment ‘the sack’ would cease to play its role as a disciplinary measure. The social position of the boss would be undermined and the self assurance and class consciousness of the working class would grow.”^[153] That would lead to “[s]trikes for wage increases and improvements in conditions of work,” which “would create political tension.”^[154] In response, Kalecki argued, “the ‘captains of industry’ would be anxious to ‘teach [the workers] a lesson’”—which they would do by “induc[ing] the [g]overnment to return to the orthodox policy of cutting down the budget deficit.”^[155] That, he contended, is essentially what happened in 1937 in the United States, as President Roosevelt prematurely pivoted to deficit reduction, thus extending the Great Depression.^[156]

Kalecki wrote specifically about fiscal policies that promoted full employment. But the point generalizes to any employment protection that significantly enhances worker bargaining power—including benefits programs like the ones Congress expanded during the depths of the pandemic. When the Reagan Administration sought to cut welfare, Piven and Cloward explained that action with an argument very similar to Kalecki’s. “The income-maintenance programs,” they said, “are coming under assault because they limit profits by enlarging the bargaining power of workers with employers.”^[157]

The same sort of thing happened with the Great Retrenchment. The COVID-era benefits expansions seemed to create a major shift in bargaining power in the workplace. And employers mobilized to keep them as short-term as possible and to eliminate them as soon as they could.^[158] Given the initial crisis, they could not stop the benefits expansions from occurring entirely.^[159] But they could act to ensure those expansions ended quickly. And they probably felt a particular incentive to make sure the rollback happened quickly. They wanted to return to normal as soon as possible, and the rare instances in which Congress has taken away a new benefit have tended to occur very early in the benefit’s life.^[160]

B. Universalism, Policy Feedback, and the Battle for Social Meaning

So, businesses had a strong incentive to fight to roll back the COVID benefits expansions. Still, Democrats who supported making the expansions permanent might have thought beneficiaries would effectively resist their benefits being taken away. That, of course, was the central point of the entrenchment theory on which they relied in expecting that nominally short-term benefits expansions would, as a practical political matter, be impossible to undo.^[161]

But Democratic supporters of the expansions did not fully prepare for a key move made by the opponents of entrenchment. Supporters thought that the benefits expansions would set a new baseline of expectations among beneficiaries and the public—that people would understand the expanded benefits as effectively an entitlement. That the expansions in key respects moved us closer to universalism made the point more plausible. People could get used to receiving checks from the government and to the assurance that they would have affordable health coverage.

The business-led coalition that sought to roll back the benefits expansions had its own story about what those expansions meant—and that story was emphatically not that the expansions set a new, more universalist, baseline of expectations for health and welfare programs in the United States. They framed the expansion as consistent with general principles of providing limited beneficence to especially needy and deserving recipients—the “deserving poor” who have been the target beneficiaries of largesse since the English Poor Laws.^[162] The COVID pandemic, they contended, constituted a unique short-term emergency, in which more people needed assistance due to no fault of their own. But any effort to extend the expansions beyond that emergency, they argued, threatened to improperly transform the underlying programs from ones for particularly needy and deserving recipients to more universal benefits programs.

Business leaders and their allies thus actively sought to manage how the public understood the benefits expansions.^[163] As the expansions wore on, they increasingly described these programs as having overstretched their limited role. We have already seen how they did this with unemployment insurance. In that context, business leaders and allied politicians increasingly complained that the benefits expansions were leading able workers to stay home—something they described as an abuse of the unemployment system.^[164] Their complaints rested on the widespread understanding of unemployment insurance as a short-term benefit for people who cannot work due to a downturn, rather than a cushion to give individuals the financial wherewithal to hold out for particularly desirable work.^[165]

Business leaders were very successful in framing the narrative around unemployment insurance. Professor Alex Hertel-Fernandez found that “during the critical period in mid-2021 when the Administration and Congress were debating further expansions and possible reform of the UI system, coverage about UI tended to focus disproportionately on claims that the system was contributing to labor shortages,” and “articles were more likely to feature interviews of business owners than workers by nearly a two-to-one ratio.”^[166] Such skewed coverage seems to have “made a considerable difference in turning public opinion against the UI system and its beneficiaries.”^[167]

The idea that cash benefits should be provided only temporarily—during limited periods when individuals were particularly in need through no fault of their own—was of course the key public justification for the 1996 welfare reform law, the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA).^[168] That law ended the old Aid to Families with Dependent Children entitlement and substituted a new non-entitlement program, tellingly entitled Temporary Assistance to Needy Families (TANF).^[169] The law imposed time limitations on the receipt of TANF benefits, and it also imposed work requirements on beneficiaries.^[170] The goal of these provisions, expressed by many of PRWORA’s supporters, was to ensure that “Welfare Should Not Be a Way of Life.”^[171]

It’s not surprising that unemployment insurance—which has long been understood as a temporary program—would be effectively framed in a similar way. What’s perhaps more interesting is that opponents of the COVID-era benefits expansion adopted exactly the same framing for Medicaid. People don’t tend to think of health insurance as something that is temporary, and—though this is more controversial—many people don’t think of health insurance as something that should be provided only to those who “deserve” it.^[172] Indeed, although early versions of the bill that became PRWORA included provisions that would have swept Medicaid as well as AFDC into the new non-entitlement block grant program, negotiators removed those provisions before final passage.^[173] Nonetheless, many observers thought that Medicaid would be the next target of welfare reformers—though that expectation quickly reversed with the incremental expansions of Medicaid in the ensuing years, including the creation of CHIP. With those additions, “Medicaid came to be perceived as a partial solution to uninsurance among low-income workers—so much so that both candidates in the 2000 Presidential election promised major expansions.”^[174] And the enactment of the ACA seemed to cement the understanding that Medicaid was not just a short-term safety net. In Chief Justice Roberts’s words, the ACA “transformed” Medicaid

into a program to meet the health care needs of the entire nonelderly population with income below 133 percent of the poverty level. It is no longer a program to care for the neediest among us, but rather an element of a comprehensive national plan to provide universal health insurance coverage.^[175]

But as Professors Patashnik and Zelizer have pointed out, it is often contestable whether a policy should be properly understood as temporary. “[I]n an era characterized by elite polarization,” we can expect the issue to be not just contestable but contested.^[176]

And that’s exactly what happened with Medicaid under COVID. As the Medicaid rolls swelled under the COVID expansions, business leaders and their allies seized the opportunity to reverse this post-ACA understanding of the program—and to return to the notion of Medicaid as short-term welfare that Republicans had left on the cutting room floor when finalizing PRWORA. Matters came to a head in the negotiations over the 2023 Consolidated Appropriations Act, the law that ultimately decreed the Medicaid “unwinding.”^[177] While that law was in the final days of being crafted, the Wall Street Journal ran a column criticizing President Biden for keeping the COVID public health emergency declaration in place. The column argued that Biden wasn’t motivated by the persistence of harmful effects of COVID infection, but instead kept the public health emergency in place because of “Medicaid, which the White House seeks to expand into something it was never meant to be.”^[178] In particular, the column argued that Biden sought to retain the continued eligibility requirement so he could transform Medicaid from “a temporary safety net for those who fall on hard times” to “a publicly funded long-term insurer.”^[179] Wall Street Journal had run a similar column a month earlier.^[180] In between, the paper ran an editorial criticizing the Biden Administration for “repeatedly extend[ing] the national public-health emergency for no ostensible purpose other than to expand the welfare rolls”—with the Medicaid continuous enrollment provision a key example.^[181]

The equation of Medicaid with “welfare,” and the premise that Medicaid should be time-limited and confined to those who truly need and deserve it (under some criteria), was thus an essential part of the public case for the Medicaid unwinding. Two years after the unwinding, that framing of Medicaid—as temporary assistance for those who are especially deserving and needy—became the key conceptual element the Trump Administration used to sell the massive Medicaid cuts in the OBBBA. Four senior Trump Administration officials made that framing clear in an op-ed they published in the New York Times while the bill was under consideration. In that op-ed, HHS Secretary Robert F. Kennedy, Jr., Centers for Medicare and Medicaid Services Administrator Mehmet Oz, Agriculture Secretary Brooke Rollins, and Housing and Urban Development Secretary Scott Turner described “the largest welfare programs in the nation” as including “the Supplemental Nutrition Assistance Program, Medicaid and federal housing assistance”—thus explicitly categorizing Medicaid as “welfare.”^[182] House Speaker Mike Johnson described the new Medicaid work requirements not as “cuts” but as “reducing fraud, waste, and abuse that is rampant in Medicaid to ensure that program, which is essential for so many people, ensure that it’s available for the most vulnerable.”^[183] He elaborated that “able-bodied workers” ought not to receive Medicaid, so throwing them off the rolls would not properly count as a cut to the program.^[184] At a hearing on the bill, House Budget Chair Jodey Arrington said the Medicaid work requirements “reflect[] the basic belief that public assistance should serve as a bridge to self-sufficiency, and not as a long-term substitute for work.”^[185] And Republican Representative Jeff Hurd reflected the general view articulated by the bill’s supporters when he said, in an interview with Colorado Public Radio, that “[i]t’s the individuals who are otherwise able-bodied, adults who are able to work and contribute that should, I think, be contributing towards Medicaid and it’s not appropriate to take money from the most needy and give it to those who don’t have that need.”^[186]

With the passage of the OBBBA, the official story is now that Medicaid is very much like cash welfare post-PRWORA. We are a very long way from the vision of Medicaid as “an element of a comprehensive national plan to provide universal health insurance coverage.”^[187]

Perhaps it did not have to be this way. Democrats seemed to take as a given that once people receive benefits they will mobilize to keep them. So, they never worked to sell a vision of the COVID CTC expansions as a step to a universal system, or of the COVID Medicaid provisions as a step to universal health care (even though it moved very substantially in that direction in practice). And they never pushed back on Republican arguments that the expanded benefits programs were being abused by undeserving beneficiaries.^[188] They took for granted that the policies they adopted would sell themselves.

One lesson of the COVID experience is, perhaps, that whether expanded benefits are durable will depend in significant part on the efforts that leaders undertake to frame them for the public. As Professor Hertel-Fernandez stated:

[I]t is not enough to simply pursue good policy and hope that the benefits of that policy will be covered favorably by the media and lead to positive narratives about target populations. Politicians and their allies need to craft and deploy positive messages about their policies—and be prepared to counter negative narratives that emerge from opponents and those skeptical of policy advances.^[189]

This point is consistent with the argument of Professors David Dagan and Steven Teles “that policy effects become policy feedback only through a process of construction.”^[190] It is also consistent with a point I have emphasized in prior work that what policies are understood as “universal” or as “targeted” depends on social meaning rather than merely on material impact.^[191]

C. Can Durable Benefits Expansion Precede Expansion of Worker Power?

The Democrats who thought that the COVID-era expansions would be durable acted on the basis of a plausible view of political economy—that expanded benefits create their own constituencies, which fight to defend them. They sought to use the opportunity of a once-in-a-century pandemic, which opened policy space for significant benefits expansion, to entrench a much more generous welfare state.

The notion that a crisis can open the door to significant, durable change itself has a strong pedigree in the political science work on policy feedback and path dependence. Work in this vein emphasizes that although the “political system . . . displays considerable stability with regard to the manner in which it processes issues,” the system’s “stability is punctuated with periods of volatile change.”^[192] During these periods—which the literature often refers to as “critical junctures”—“opportunities for major institutional reforms [to] appear,” typically “attributed to big, exogenous shocks.”^[193] Professors Capoccia and Kelemen describe critical junctures as situations “in which the structural (that is, economic, cultural, ideological, organizational) influences on political action are significantly relaxed for a relatively short period,” with the result that “the range of plausible choices open to powerful political actors expands substantially.”^[194] It was entirely plausible to think that the COVID pandemic presented us with just such a “critical juncture.”

But those who sought to entrench the COVID expansions were unable, given the political alignments at the time, to take effective action to bolster the political power of the beneficiaries of their expanded programs. And their actions that expanded the workplace power of these beneficiaries threatened a set of powerful interests. This left the policies vulnerable to the reaction by business and allied politicians.^[195]

Progressive analysts are increasingly converging on the conclusion that a key reason Biden Administration policies failed to entrench themselves is that the Administration did not “intensively and strategically build power among the target populations most affected by policy and most crucial for altering existing power dynamics.”^[196] But the problem is more difficult than simply deciding to focus on building political power as a part of benefits program design. After all, there’s a reason why Democrats did not have the votes to make their COVID benefits expansions permanent from the beginning. And, as Professor Michener notes, “there was organizing around the CTC: For example, national, state, and local organizations embedded voter registration efforts into larger campaigns to inform people about the CTC benefits and help them file taxes.”^[197] Yet none of it was enough to save the COVID expansions from a complete rollback—and from setting the stage for an even further rollback of Medicaid.

The problem of power is thus an essential one for policymakers who wish to move toward universalism to address. At first, the problem might appear hopeless: If entrenched business interests will resist durable universal (or more universal) benefits programs because of the threat to their power, how can advocates of those programs succeed unless they have already accomplished the power shift the programs are designed to achieve? Along these lines, Professors Alex Gourevitch and Lucas Stanczyk have argued that any UBI policy that would be robust enough to meaningfully shift workplace bargaining power cannot be enacted without labor first having much more significant political power.^[198] They contend that

[b]ecause a livable basic income would be a truly massive redistributive program, ultimately to be paid for out of existing and potential business profits, it will come only when there is a working class organized and powerful enough to be able to extract it, in spite of the inevitable fierce opposition of the owners of capital.^[199]

As a result, they contend, “efforts to secure broad consensus on the virtues of legislating a livable basic income cannot plausibly be prioritized over what is needed to organize the working class as a political force and reinvigorate the labor movement.”^[200]

One might, therefore, conclude that the only way to achieve a durable move towards universal cash and health benefits programs is to first take effective steps to expand the power of workers and collective bargaining. Only once we have invigorated the labor movement, one might say, can we make truly transformational progress in benefits policy. There is of course substantial truth to that suggestion—not only as a matter of abstract analysis but also as a matter of concrete experience. The major benefits expansions we have seen in the past—the enactment of Social Security in 1935, the enactment of Medicare and Medicaid in 1965—have occurred at times when the labor movement was strong.^[201]

But efforts to invigorate labor face the same political hurdles as do efforts to move toward universal benefits—if not more so. The Biden Administration, after all, took a number of steps to promote labor power,^[202] but it was unable to muster the votes to push through the PRO Act, labor’s major legislative priority^[203]—and even that legislation would have been only the first step in a very long struggle.^[204]

At this moment, when the prospects for any major progressive change seem bleak, it does not make sense to dogmatically insist that any one form of that change must precede another. Rather, policymakers must be alert to opportunities to expand progressive policy along whatever margin they can. In this respect, one ought not criticize the architects of the COVID benefits expansions for focusing first on benefits policy before turning to issues of political power—there was a crisis, which required action to save lives and prevent destitution, and which opened up space for expansive benefits policies. But if the politics made it necessary, perhaps it would have been worth it to expand fewer benefits programs but do so for longer. The Biden Administration could also have done much more to frame its work unapologetically as moving toward universalism—particularly in the area of health coverage. And the administration—and especially supportive outside groups—could have done more, at least at the margins, to use the expanded benefits as a tool to mobilize beneficiaries to keep those expansions in place.

But the final lesson of COVID and the Great Retrenchment may be that, in our highly polarized political world, the mechanisms that once may have promoted policy entrenchment no longer have the same power.^[205] Until there is a major shift in the broader array of political forces, we may be stuck fighting back and forth in a game of inches seeking to expand or defend particular social programs. And that may, in the end, be the argument for focusing on expanding labor power—to change the terms of the game, though doing so is a long-term project whose prospects are uncertain at best.

V. Conclusion

In this Article, I have described the dramatic expansion of federal benefits programs during the COVID pandemic—an expansion that moved significantly in the direction of universalism—and the equally dramatic retrenchment that followed. Indeed, in some respects, the retrenchment was even more dramatic than the expansion—as the elimination of COVID-era health benefits set the stage for rolling back significant parts of the pre-COVID ACA regime.

I have argued that the Great Retrenchment calls into question a standard story about the durability of benefits programs—and, in particular, the durability of programs that extend benefits to a broad swath of the public. I have called especial attention to the interests of businesses in resisting benefits expansions, because those expansions enhance workers’ bargaining power. Employers will vindicate their interests, I have argued, by actively seeking to frame the meaning of benefits expansions for the public. In the case of the COVID expansions, business interests succeeded in this battle for social meaning—framing the expansions, and even underlying programs like Medicaid, as temporary help rather than broad entitlements. That framing set the stage for the Trump Administration’s further cuts to Medicaid in particular.

A key lesson of the Great Retrenchment, I argue, is that the mechanisms that previously promoted entrenchment of benefits expansions no longer have the same power they once did. And that means that advocates of these expansions need to focus as much on reforms that expand the political power of working people as on programs that provide benefits to working people. The latter will not be sufficiently generous or durable without the former.

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1. Andrew Hammond, Ariel Jurow Kleiman & Gabriel Scheffler, The Future of Anti-Poverty Legislation, 112 Geo. L.J. 349, 358–61 (2023).

2. See infra text accompanying notes 85–86.

3. See infra Section III.E. As I discuss below, this analysis includes both the effects of the Medicaid cuts already included in the One Big Beautiful Bill Act and the effects of Congress’s failure to extend the expanded subsidies for insurance purchased on ACA exchanges. See infra text accompanying notes 4, 121–26. As of this writing, any effort to revive the ACA subsidies appears to be dead. See Joseph Choi, Senate Talks to Revive ACA Tax Credits Appear to be Fizzling Out, The Hill (Feb. 4, 2026, at 18:53 ET), https://thehill.com/policy/healthcare/5723559-moreno-collins-proposal-fizzles/ [https://perma.cc/9JVT-PDY6].

4. One Big Beautiful Bill Act, Pub. L. No. 119-21, 139 Stat. 72 (2025).

5. See infra text accompanying notes 85–86, 121–32, 174–75.

6. See Samuel R. Bagenstos, Disability, Universalism, Social Rights, and Citizenship, 39 Cardozo L. Rev. 413, 418, 423–24 (2017). See generally William P. Quigley, Five Hundred Years of English Poor Laws, 1349-1834: Regulating the Working and Nonworking Poor, 30 Akron L. Rev. 73 (1996) (describing the development of the English Poor Laws).

7. See infra text accompanying notes 127–30.

8. For the point of origin, see generally Paul Pierson, Dismantling the Welfare State?: Reagan, Thatcher, and the Politics of Retrenchment (1994), but there are many more entries in the literature, some of which I will discuss later in this Article. See infra notes 16–18 and accompanying text. See generally Gabriel Scheffler, The Ghosts of the Affordable Care Act, 101 Wash. U. L. Rev. 791 (2024) (noting “the conventional wisdom that legislation which confers major social benefits is incredibly difficult to dismantle” and citing sources).

9. See, e.g., Daniel Béland, Philip Rocco & Alex Waddan, Policy Feedback and the Politics of the Affordable Care Act, 47 Pol’y Stud. J. 395, 397–98, 400–01 (2019) (arguing that “policies can indeed generate both self-reinforcing and self-undermining feedback effects”); Eric M. Patashnik & Julian E. Zelizer, The Struggle to Remake Politics: Liberal Reform and the Limits of Policy Feedback in the Contemporary American State, 11 Persps. on Pol. 1071, 1072 (2013) (arguing “that the capacity of public policies to remake politics is contingent, conditional, and contested”).

10. See infra text accompanying notes 89–124.

11. See Eric M. Patashnik, Countermobilization: Policy Feedback and Backlash in a Polarized Age 174 (2023) (concluding that “most, but not all, backlashes happen during or shortly after policy enactment” (emphasis omitted)); Béland, Rocco & Waddan, supra note 9, at 396 (“According to the policy feedback literature, ‘immature’ programs are more vulnerable to retrenchment and outright dismantling than programs that have been around for a long period of time, at least when these more established programs produce positive, self-reinforcing feedback effects.”); Scheffler, supra note 8, at 843 (noting reforms are “most vulnerable” during their early years).

12. See infra Part IV.A.

13. See Patashnik, supra note 11, at 101 (“By the time this political window of opportunity opened, however, the ACA’s marketplace subsidies and insurance benefits were fully in effect and the law had begun to generate significant positive feedback.”).

14. For a good discussion of the general phenomenon, see generally Anne Schneider & Helen Ingram, Social Construction of Target Populations: Implications for Politics and Policy, 87 Am. Pol. Sci. Rev. 334 (1993). See also Paul Pierson, When Effect Becomes Cause: Policy Feedback and Political Change, 45 World Pol. 595, 624–25 (1993) (arguing that policy feedback has two main mechanisms: “resource/incentive effects and interpretive effects”).

15. See infra text accompanying notes 177–86.

16. See E.E. Schattschneider, Politics, Pressures, and the Tariff 288 (1935) (stating that “[n]ew policies create a new politics”).

17. See infra text accompanying notes 127–28.

18. See, e.g., Scheffler, supra note 8, at 799 (explaining that “interest group dynamics tend to make undoing social programs difficult: once these programs are established and implemented, they provide concentrated benefits, while their costs are dispersed much more broadly”). See generally James Q. Wilson, The Politics of Regulation, in The Politics of Regulation 357 (James Q. Wilson ed., 1980) (arguing that programs with concentrated benefits and diffused costs are difficult to displace).

19. See Patashnik & Zelizer, supra note 9, at 1072 (arguing that “[a]ctors who seek to influence the sustainability of a given policy may not accept feedback processes as they find them,” and in particular that “opponents, especially economically privileged clienteles who stand to lose governmental subsidies and benefits, may seek to undermine it”).

20. In this regard, my conclusions accord with those of Jamila Michener, Policy Feedback in the Pandemic: Lessons from Three Key Policies 26 (2023), https://rooseveltinstitute.org/wp-content/uploads/2023/10/RI_Policy-Feedback-in-the-Pandemic_Report_202310.pdf [https://perma.cc/MHV6-GSQZ]. See generally Alexander Hertel-Fernandez, How Policymakers Can Craft Measures That Endure and Build Political Power (Roosevelt Inst., Working Paper, 2020), https://rooseveltinstitute.org/wp-content/uploads/2020/07/RI_How-Policymakers-Can-Craft-Measures-that-Endure-and-Build-Political-Power-Working-Paper-2020.pdf [https://perma.cc/CE3Q-QBWM] (setting forth a framework for crafting policies that will generate positive political feedback).

21. See Walter Korpi & Joakim Palme, The Paradox of Redistribution and Strategies of Equality: Welfare State Institutions, Inequality, and Poverty in the Western Countries, 63 Am. Socio. Rev. 661, 662 (1998).

22. See 42 U.S.C. §§ 409–414; Social Security Credits, Soc. Sec., https://www.ssa.gov/benefits/retirement/planner/credits.html [https://perma.cc/4NFK-F3BS] (last visited Jan. 10, 2026). The exclusions of domestic and farm labor from Social Security as originally enacted had the clear effect of reinforcing existing racial and gender subordination. See Bagenstos, supra note 6, at 415 (“[T]he famously ‘universal’ programs of the New Deal were anything but. They often carved African Americans in the South out of their protections, all to smooth their passage in a divided and compromised Democratic Congress. In addition to reinforcing existing structures of racial subordination, those supposedly universal laws also reinforced subordination in gender relations.” (footnote omitted) (first citing Ira Katznelson, Fear Itself: The New Deal and the Origins of Our Time (2013); then citing Alice Kessler-Harris, In Pursuit of Equity: Women, Men, and the Quest for Economic Citizenship in 20th-Century America (2001); and then citing Suzanne Mettler, Dividing Citizens: Gender and Federalism in New Deal Public Policy (1998))).

23. See 8 U.S.C. § 1611; 42 U.S.C. § 414(c).

24. This is broadly consistent with the way Korpi & Palme, supra note 21, at 669, understand these categorizations.

25. See T.H. Marshall, Citizenship and Social Class 8 (1950); see also Richard Pulvera et al., The Association of Safety-Net Program Participation with Government Perceptions, Welfare Stigma, and Discrimination, Health Aff. Scholar, Jan. 2024, at 1, 4–5 (2024) (discussing stigma associated with receiving SNAP benefits). For my prior effort to explore (and explore some problems with) this argument, see generally Bagenstos, supra note 6 (examining how Marshall’s argument accords with more recent experience in United States social welfare programs).

26. See Michael B. Katz, The Undeserving Poor: America’s Enduring Confrontation with Poverty 89 (2d ed. 2013).

27. . Joe Soss, Richard C. Fording & Sanford F. Schram, Disciplining the Poor: Neoliberal Paternalism and the Persistent Power of Race 295 (2011) (arguing that welfare programs “enforce work through the principle of less eligibility, pushing the poor into the least attractive jobs by keeping benefits low, making them inaccessible, and surrounding them with stigma”); Robert S. Taylor, Exit Left: Markets and Mobility in Republican Thought 93–94 (2017) (arguing that administering conditional or targeted benefits “requires that discretionary power be given to welfare agents, both to determine whether the conditions are being met (assessment, including investigatory powers of various sorts) and to cut off aid if they fail to be met (redress),” all of which gives welfare officials “a degree of arbitrary power over recipients”); Jacobus tenBroek & Floyd W. Matson, The Disabled and the Law of Welfare, 54 Calif. L. Rev. 809, 831 (1966) (“[T]he recipient is told what he wants as well as how much he is wanting.”). See generally Frances Fox Piven & Richard A. Cloward, Regulating the Poor: The Functions of Public Welfare (2d ed. 1993) (arguing that welfare programs have been employed as a means of social control).

28. See generally Pamela Herd & Donald P. Moynihan, Administrative Burden: Policymaking by Other Means (2018) (detailing the barriers created by administrative burdens in social programs).

29. See Ugo Colombino, Is Unconditional Basic Income a Viable Alternative to Other Social Welfare Measures? 1 (2019), https://wol.iza.org/uploads/articles/475/pdfs/is-unconditional-basic-income-viable-alternative-to-other-social-welfare-measures.one-pager.pdf?v=1 [https://perma.cc/G6ES-42U9].

30. See Bagenstos, supra note 66, at 425 (“Many of the architects of the American social welfare state . . . believed that ‘programs for the poor are poor programs.’ When poor people are singled out for particular benefits, they argued, the beneficiaries become stigmatized and the benefits become politically vulnerable.” (footnote omitted)). Note that I am merely restating a widely accepted argument here; I am not myself fully endorsing it. As Robert Greenstein notes, the evidence is far more nuanced. See Robert Greenstein, The Hamilton Project, Targeting vs. Universalism, and Other Factors That Affect Social Programs’ Political Strength and Durability 13–15 (2022), https://www.hamiltonproject.org/wp-content/uploads/2023/01/20220806_ES_THP_SocialPrograms_ExpandedEdition.pdf [https://perma.cc/5WVX-KVHY]. What may matter more than universalism is that a program, even if remaining targeted or means tested in some way, covers a wide swath of the middle class. See Mark Schmitt, Medicaid Saved the Affordable Care Act. Liberals Should Take Notice, Vox (Aug. 2, 2017, at 10:20 CT), https://www.vox.com/the-big-idea/2017/8/2/16083310/medicaid-targeted-aca-univeral-programs-safety-net [https://perma.cc/WCH2-9XWQ].

31. See Bagenstos, supra note 6, at 417–18 (“Whether a social welfare program has the political benefits attributed to universalism depends on the social meaning of that program, rather than on its formal rules for eligibility. That social meaning, in turn, depends crucially on the broader political context, as well as the efforts of activists to shape the public understanding of the program.” (footnote omitted)); Samuel R. Bagenstos, Universalism and Civil Rights (with Notes on Voting Rights After Shelby), 123 Yale L.J. 2838, 2854 (2014) (“[I]t is far from obvious that the social and political understanding of a law will so closely track its legal form. To the contrary, even a universalist law that is motivated by a desire to serve a particular group may soon be understood as essentially targeting that group.”).

32. See discussion infra Section IV.B.

33. See American Rescue Plan Act of 2021, Pub. L. No. 117-2, § 9901, 135 Stat. 4, 223–33. For discussions of the terms of the SLFRF, see Texas v. Yellen, 105 F.4th 755, 762 (5th Cir. 2024); West Virginia ex rel. Morrisey v. U.S. Dep’t of the Treasury, 59 F.4th 1124, 1132–34 (11th Cir. 2023).

34. See Coronavirus Aid, Relief, and Economic Security Act, Pub. L. No. 116-36, 134 Stat. 281, 508 (2020); Coronavirus Food Assistance Program; Additional Assistance, 86 Fed. Reg. 4877, 4877 (Jan. 19, 2021).

35. See Coronavirus Aid, Relief, and Economic Security Act § 1102, 134 Stat. at 286.

36. See id. 134 Stat. at 536. See generally Hosp. for Special Surgery v. Becerra, No. 22-2928 (JDB), 2023 WL 5448017, at *1 (D.D.C. Aug. 24, 2023) (describing the Provider Relief Fund).

37. See Consolidated Appropriations Act, 2021, Pub. L. No. 116-260, § 501, 134 Stat. 1182, 2069–73 (2020); American Rescue Plan Act of 2021, Pub. L. No. 117-2, § 3201, 135 Stat. 4, 54–58. See generally Darby Dev. Co. v. United States, 112 F.4th 1017 (Fed. Cir. 2024) (discussing the federal government’s interventions on behalf of renters during the depths of the pandemic).

38. American Rescue Plan Act of 2021 § 1; See American Rescue Plan, U.S. Econ. Dev. Admin., https://www.eda.gov/funding/programs/american-rescue-plan [https://perma.cc/AVS6-RCV6] (last visited Jan. 9, 2026).

39. See § 9611, 135 Stat. at 144–45 (adding new subsection (i) to 26 U.S.C. § 24).

40. How Did the 2021 American Rescue Plan Act Change the Child Tax Credit?, Tax Pol’y Ctr. (Jan. 2024) [hereinafter Tax Pol’y Ctr], https://taxpolicycenter.org/briefing-book/how-did-2021-american-rescue-plan-act-change-child-tax-credit [https://perma.cc/C8QE-BKET].

41. See Pamela Herd & Donald Moynihan, Implementing the Expanded Child Tax Credit: What Worked, What Didn’t, and How to Move Forward, 710 Annals Am. Acad. Pol. & Soc. Sci. 58, 59–60, 67 (2023) (“The policy redesign of the expanded CTC followed the targeting-within-universalism playbook. The base of beneficiaries was expanded, and the distribution of resources became more progressive by incorporating families with lower incomes.”).

42. See Kalee Burns, Liana Fox & Danielle Wilson, Expansions to Child Tax Credit Contributed to 46% Decline in Child Poverty Since 2020 (Sep. 13, 2022), https://www.census.gov/library/stories/2022/09/record-drop-in-child-poverty.html [https://perma.cc/9HN5-R8US].

43. Tax Pol’y Ctr., supra note 40. Whether the expanded credit was completely responsible for this result is a harder question. See Marianne P. Bitler, The Effects of the 2021 Child Tax Credit on Poverty, 710 Annals Am. Acad. Pol. & Soc. Sci. 75, 87 (2023) (“First, it is clear that the expanded 2021 CTC was associated with a considerable static reduction in poverty in the short run, but we do not know the whole story yet about the exact causal effects of this CTC expansion. It may be that dynamic responses among benefit recipients make the causal effects different than what is shown in these descriptive static comparisons.”).

44. See Nicole C McCann et al., Association Between Child Tax Credit Advance Payments and Food Insufficiency in Households Experiencing Economic Shocks, Health Affs. Scholar, Feb. 2024, at 1, 8; Zachary Parolin et al., The Initial Effects of the Expanded Child Tax Credit on Material Hardship 23–25 (Nat’l Bureau of Econ. Rsch., Working Paper No. 29285, 2021), https://www.nber.org/system/files/working_papers/w29285/w29285.pdf [https://perma.cc/R3Q2-SLQ3].

45. See Elizabeth Ananat et al., Effects of the Expanded Child Tax Credit on Employment Outcomes: Evidence from Real-World Data from April to December 2021, at 20 (Nat’l Bureau of Econ. Rsch., Working Paper No. 29823, 2022), https://www.nber.org/system/files/working_papers/w29823/w29823.pdf [https://perma.cc/XM42-J9C6]; see also Tax Pol’y Ctr., supra note 40 (noting that “[m]ost, but not all, analysts have found that the CTC did not significantly reduce employment, or that employment rates did not significantly differ between recipients and nonrecipients,” and that “[r]eceiving the credit may have even increased employment by enabling parents to pay for childcare”).

46. Claire Zippel, 9 in 10 Families with Low Incomes Are Using Child Tax Credits to Pay for Necessities, Education, Ctr. on Budget & Pol’y Priorities (Oct. 21, 2021, at 05:00 CT), https://www.cbpp.org/blog/9-in-10-families-with-low-incomes-are-using-child-tax-credits-to-pay-for-necessities-education [https://perma.cc/T9NR-RHQ3].

47. See American Rescue Plan Act of 2021, Pub. L. No. 117-2, §§ 9621–26, 135 Stat. 4, 152–58.

48. See id. § 9621.

49. See Jiwan Lee et al., Effects of the Expansion of the Earned Income Tax Credit for Childless Young Adults on Material Wellbeing 26 (Nat’l Bureau of Econ. Rsch., Working Paper No. 32571, 2024), https://www.nber.org/system/files/working_papers/w32571/w32571.pdf [https://perma.cc/XLF8-PRWJ].

50. Robust COVID Relief Achieved Historic Gains Against Poverty and Hardship, Bolstered Economy, Ctr. on Budget & Pol’y Priorities (June 14, 2022) [hereinafter Robust COVID Relief], https://www.cbpp.org/research/poverty-and-inequality/robust-covid-relief-achieved-historic-gains-against-poverty-and-0 [https://perma.cc/XJ7N-WRVV].

51. Coronavirus Aid, Relief, and Economic Security Act, Pub. L. No. 116-136, § 2201, 134 Stat. 281, 335 (2020).

52. Consolidated Appropriations Act, 2021, Pub. L. No. 116-260, § 272, 134 Stat. 1182, 1965 (2020).

53. American Rescue Plan Act of 2021 § 9601.

54. See Kris Cox, Samantha Jacoby & Chuck Marr, Stimulus Payments, Child Tax Credit Expansion Were Critical Parts of Successful COVID-19 Policy Response, Ctr. on Budget & Pol’y Priorities (June 22, 2022), https://www.cbpp.org/research/federal-tax/stimulus-payments-child-tax-credit-expansion-were-critical-parts-of-successful [https://perma.cc/8Y58-47RG].

55. Steven Raphael & Daniel Schneider, Introduction: The Socioeconomic Impacts of COVID-19, RSF: Russell Sage Found. J. Soc. Scis., May 2023, at 1, 13.

56. See, e.g., Matt Stevens & Isabella Grullón Paz, Andrew Yang’s $1,000-a-Month Idea May Have Seemed Absurd Before. Not Now., N.Y. Times (Jan. 18, 2021), https://www.nytimes.com/2020/03/18/us/politics/universal-basic-income-andrew-yang.html [https://perma.cc/BXN4-3FMZ]; Jana Kasperkevic, Universal Basic Income Was a Fringe Idea. Then the COVID-19 Pandemic Happened., Marketplace (Apr. 6, 2020), https://www.marketplace.org/story/2020/04/06/universal-basic-income-was-a-fringe-idea-then-the-covid-19-pandemic-happened [https://perma.cc/NPT4-EAU9]; Lorie Konish, Some Families Could Get More Than $14,000 in New Covid Relief. It’s Looking More and More Like Universal Basic Income, CNBC (Feb. 25, 2021, at 16:51 ET), https://www.cnbc.com/2021/02/25/how-some-families-could-get-more-than-14000-in-new-covid-relief.html [https://perma.cc/55KP-ML3A].

57. Robust COVID Relief, supra note 50.

58. See id.

59. See id. See generally Herd & Moynihan, supra note 41 (describing how administrative burdens limit uptake of social programs).

60. Jurgen De Wispelaere, Joe Chrisp & Leticia Morales, Basic Income in Crisis? (Hard) Lessons from the Pandemic, 16 Glob. Pol’y 167, 167–68 (2025).

61. See Gillian Lester, Unemployment Insurance and Wealth Redistribution, 49 UCLA L. Rev. 335, 341−43 (2001) (noting that stabilizing the economy during downturns was a goal of unemployment insurance).

62. Pandemic Response Accountability Comm., Key Insights: State Pandemic Unemployment Insurance Programs 3 (2021), https://pandemicoversight.gov/media/file/state-unemployment-insurance-capping-report [https://perma.cc/TCX8-AZAU].

63. See Coronavirus Aid, Relief, and Economic Security Act, Pub. L. No. 116-136, § 2102, 134 Stat. 281 (2020).

64. Id. § 2104.

65. See id. § 2107 (the “Pandemic Emergency Unemployment Compensation” provision).

66. See Consolidated Appropriations Act, 2021, Pub. L. No. 116-260, § 201, 134 Stat. 1182, 1950 (2020); American Rescue Plan Act of 2021, Pub. L. No. 117-2, §§ 9011, 9013, 135 Stat. 4, 118–19.

67. See Brian Galle, The American Rescue Plan and the Future of the Safety Net, 131 Yale L.J.F. 561, 569 (2021).

68. Raphael & Schneider, supra note 55, at 12. On the health consequences specifically, see Julia Raifman, Jacob Bor & Atheendar Venkataramani, Association Between Receipt of Unemployment Insurance and Food Insecurity Among People Who Lost Employment During the COVID-19 Pandemic in the United States, JAMA Network Open, Jan. 2021, at 1, 9.

69. See Families First Coronavirus Response Act, Pub. L. No. 116-127, § 3102, 134 Stat 178, 189 (2020); Andrew R. Turnbull, President Trump Signs the Families First Coronavirus Response Act into Law, Creating Paid Family and Sick Leave for Employees, Morrison & Foerster (Mar. 20, 2020), https://elc.mofo.com/topics/families-first-coronavirus-response-act-paid-family-sick-leave [https://perma.cc/26C9-EJY3].

70. Lindsay F. Wiley & Samuel R. Bagenstos, The Personal Responsibility Pandemic: Centering Solidarity in Public Health and Employment Law, 52 Ariz. St. L.J. 1235, 1281–82 (2020).

71. Id. at 1282.

72. See Consolidated Appropriations Act, 2021, Pub. L. No. 116-260, § 286, 134 Stat. 1182, 1989–90 (2020); American Rescue Plan Act of 2021, Pub. L. No. 117-2, § 9641, 135 Stat. 4, 161, 166.

73. Families First Coronavirus Response Act § 3102.

74. See Wiley & Bagenstos, supra note 70, at 1281–82.

75. See Mary Gately & Emerson Sprick, Performance of the FFCRA Paid Leave Tax Credit, Bipartisan Pol’y Ctr. (Sep. 20, 2021), https://bipartisanpolicy.org/blog/performance-of-the-ffcra-paid-leave-tax-credit/ [https://perma.cc/5JXM-G3Z6]; see also Emma Jelliffe et al., Awareness and Use of (Emergency) Sick Leave: US Employees’ Unaddressed Sick Leave Needs in a Global Pandemic, Procs. Nat’l Acad. Scis., July 2021, at 1, 1–2, https://www.pnas.org/doi/epdf/10.1073/pnas.2107670118 [https://perma.cc/2GVN-W9QK] (finding substantial gaps in awareness and take-up of the FFCRA paid sick leave guarantee).

76. See Stefan Pichler, Katherine Wen & Nicolas R. Ziebarth, COVID-19 Emergency Sick Leave Has Helped Flatten the Curve in the United States, 39 Health Affs. 2197, 2202 (2020); Martin Andersen et al., Does Paid Sick Leave Encourage Staying at Home? Evidence from the United States During a Pandemic, 32 Health Econ. 1256, 1275–76 (2023).

77. Families First Coronavirus Response Act § 6008.

78. See Jennifer Tolbert & Meghana Ammula, 10 Things to Know About the Unwinding of the Medicaid Continuous Enrollment Provision, KFF (June 9, 2023), https://www.kff.org/medicaid/issue-brief/10-things-to-know-about-the-unwinding-of-the-medicaid-continuous-enrollment-provision/ [https://perma.cc/AJ24-PERG].

79. American Rescue Plan Act of 2021, Pub. L. No. 117-2, § 9661, 135 Stat. 4, 182–83.

80. See Act of Aug. 16, 2022, Pub. L. No. 117-169, § 12001, 136 Stat. 1818, 1905.

81. See Matthew Rae et al., How the American Rescue Plan Act Affects Subsidies for Marketplace Shoppers and People Who Are Uninsured, KFF (Mar. 25, 2021), https://www.kff.org/affordable-care-act/issue-brief/how-the-american-rescue-plan-act-affects-subsidies-for-marketplace-shoppers-and-people-who-are-uninsured [https://perma.cc/2AJZ-RQBL].

82. Jared Ortaliza et al., Inflation Reduction Act Health Insurance Subsidies: What is Their Impact and What Would Happen if They Expire?, KFF (July 26, 2024), https://www.kff.org/affordable-care-act/issue-brief/inflation-reduction-act-health-insurance-subsidies-what-is-their-impact-and-what-would-happen-if-they-expire/ [https://perma.cc/AG6B-576R].

83. Id.

84. See Fritz Farrow, Record 24 Million Enroll in Affordable Care Act Health Insurance as Biden’s Term Ends, White House Says, abc News (Jan. 8, 2025, at 04:01 CT), https://abcnews.go.com/US/affordable-care-act-enrollments-surge-bidens-term-nears/story?id=117451514 [https://perma.cc/HH78-TA9V].

85. Nat’l Fed’n of Indep. Bus. v. Sebelius, 567 U.S. 519, 583 (2012) (Roberts, C.J.) (plurality opinion).

86. Brian Tsai, U.S. Uninsured Rate Hits Record Low in First Quarter of 2023, CDC (Aug. 3, 2023), https://blogs.cdc.gov/nchs/2023/08/03/7434/ [https://perma.cc/L64V-KTFA].

87. See discussion supra Section II.B.1.

88. See discussion infra Sections III.A, E.

89. See Tara Golshan & Arthur Delaney, Joe Manchin Privately Told Colleagues Parents Use Child Tax Credit Money on Drugs, HuffPost (Dec. 20, 2021, at 05:45 ET), https://www.huffpost.com/entry/joe-manchin-build-back-better-child-tax-credit-drugs_n_61bf8f6be4b061afe394006d [https://perma.cc/NN2P-QY4L]; Fact Sheet: The American Families Plan, The White House (Apr. 28, 2021), https://bidenwhitehouse.archives.gov/briefing-room/statements-releases/2021/04/28/fact-sheet-the-american-families-plan/ [https://perma.cc/4M2L-7SH7].

90. See Megan Leonhardt, Lawmakers Push to Make $3,000 Child Tax Credit Permanent, But Biden Only Commits to 4 More Years, CNBC (Apr. 28, 2021, at 15:10 ET), https://www.cnbc.com/2021/04/28/child-tax-credit-biden-4-years-democrats-permanent.html [https://perma.cc/C47L-KY6W].

91. See Rachel Cohen Booth, Can the Expanded Child Tax Credit Come Back from the Dead?, Vox (Apr. 29, 2022, at 05:30 CT), https://www.vox.com/23040707/child-tax-credit-ctc-midterms [https://perma.cc/J5DY-AN3H].

92. Michener, supra note 20, at 5; see also id. at 9 (“Given the vast multiracial, cross-class constituency it helped, many people hoped that the popularity of the expanded CTC would prompt political elites to extend it beyond the initial one-year term, making it a permanent fixture in US social policy.”).

93. See Golshan & Delaney, supra note 89; Dylan Matthews, Who Killed the Expanded Child Tax Credit?, Vox (Apr. 18, 2022, at 07:30 CT), https://www.vox.com/future-perfect/2022/4/18/23026908/child-tax-credit-joe-manchin-policy-feedback-partisan [https://perma.cc/H4GM-AUPL].

94. See Deepa Shivaram, The Expanded Child Tax Credit Expires Friday After Congress Failed to Renew It, NPR (Dec. 30, 2021, at 14:03 ET), https://www.npr.org/2021/12/30/1069143123/expanded-child-tax-credit-expires-friday-congress [https://perma.cc/5J6K-53FV].

95. See Booth, supra note 91 (quoting Otis Rolley, Senior Vice President of the Rockefeller Foundation).

96. Joe Hughes, Lapse of Expanded Child Tax Credit Led to Unprecedented Rise in Child Poverty, Inst. on Tax’n & Econ. Pol’y (Sep. 12, 2023), https://itep.org/lapse-of-expanded-child-tax-credit-led-to-unprecedented-rise-in-child-poverty-2023/ [https://perma.cc/ZEW3-9DZ4].

97. See id.; see also Cox, Jacoby & Marr, supra note 54 (noting that the reduction in child poverty was reversed the month after the expanded CTC payments expired).

98. One Big Beautiful Bill Act, Pub. L. No. 119-21, § 70104, 139 Stat. 72, 160–61 (2025).

99. See Joshua McCabe, Indexing at Last: The Most Important Policy Change You Haven’t Heard About, Niskanen Ctr. (Aug. 5, 2025), https://www.niskanencenter.org/indexing-at-last-the-most-important-policy-change-you-havent-heard-about/ [https://perma.cc/TN8R-YDL5].

100. Policy Basics: The Child Tax Credit, Ctr. on Budget & Pol’y Priorities (Jan. 6, 2026), https://www.cbpp.org/research/policy-basics-the-child-tax-credit [https://perma.cc/A4FF-XH8P].

101. Kristin Kharrat & Emily Wielk, How the OBBB Changes to the Child Tax Credit Will Impact Families, Bipartisan Pol’y Ctr. (Aug. 7, 2025), https://bipartisanpolicy.org/blog/how-the-obbb-changes-to-the-child-tax-credit-will-impact-families/ [https://perma.cc/8ANE-4VUT].

102. See Ayelet Sheffey, Should Stimulus Checks Be Permanent? An Increasing Number of People—and Democrats—Think So., Bus. Insider (Apr. 23, 2021, at 13:44 CT), https://www.businessinsider.com/stimulus-payments-permanent-recurring-checks-democrats-universal-basic-income-2021-4 [https://perma.cc/B2YL-49ZZ]. I should withhold comment on Business Insider’s apparent belief that Democrats aren’t people. See id.

103. See Katie Lobosco, No, There Is No Fourth Stimulus Check on the Way, CNN (June 29, 2021, at 13:13 ET), https://www.cnn.com/2021/06/29/politics/stimulus-check-no-fourth-round [https://perma.cc/RCQ3-KMES]; Aimee Picchi, What’s Behind the Push for a Fourth Stimulus Check, CBS News (Feb. 11, 2022, at 07:21 ET), https://www.cbsnews.com/news/fourth-stimulus-check-update-2022-02-11/ [https://perma.cc/7UL7-P6L2].

104. De Wispelaere, Chrisp & Morales, supra note 60, at 172.

105. Amy Traub, Alexander Hertel-Fernandez & Sanjay Pinto, The Unemployed Worker Study, Nat’l Emp. L. Project (Apr. 22, 2025), https://www.nelp.org/insights-research/the-unemployed-worker-study/ [https://perma.cc/6KN2-HJU7].

106. See Wiley & Bagenstos, supra note 70, at 1285–86.

107. See Pandemic Response Accountability Comm., supra note 62, at 2, 6.

108. See Julie M. Whittaker & Katelin P. Isaacs, Cong. Rsch. Serv., R46687, Unemployment Insurance (UI) Benefits: Permanent-Law Programs and the COVID-19 Pandemic Response 13–14 (2022).

109. See Josh Bivens & Asha Banerjee, Econ. Pol’y Inst., How To Boost Unemployment Insurance as a Macroeconomic Stabilizer: Lessons from the 2020 Pandemic Programs 1–2 (2021), https://files.epi.org/uploads/234858.pdf [https://perma.cc/QQ9C-LSV8].

110. Traub, Hertel-Fernandez & Pinto, supra note 105; Diana Boesch, Ctr. for Am. Progress, The Urgent Case for Permanent Paid Leave: Lessons Learned From the COVID-19 Response 3 (2020), https://www.americanprogress.org/wp-content/uploads/sites/2/2020/08/BoeschPaidLeave-BRIEF.pdf [https://perma.cc/BF4N-CKAY].

111. See Katie Lobosco, Millions Left Without Paid Sick Leave After Congress Let Pandemic Benefit Expire, CNN (Jan. 10, 2021, at 11:12 ET), https://www.cnn.com/2021/01/10/politics/paid-sick-leave-covid-benefit-expiration [https://perma.cc/K92A-Q8JF].

112. Consolidated Appropriations Act, 2021, Pub. L. No. 116-260, § 286, 134 Stat. 1182, 1989 (2020).

113. American Rescue Plan Act of 2021, Pub L. No. 117-2, § 9641, 135 Stat. 4, 161.

114. Molly F. Sherlock, Cong. Rsch. Serv., IF11739, Payroll Tax Credit for Covid-19 Sick and Family Leave (2021).

115. See Claire Cain Miller, A Key to Returning to Normal Is Paid Medical Leave, Democrats Say, N.Y. Times (Feb. 21, 2022), https://www.nytimes.com/2022/02/21/upshot/paid-leave-covid-democrats.html [https://perma.cc/Q3Q2-2HN2].

116. Consolidated Appropriations Act, 2023, Pub. L. No. 117-328, § 5131, 136 Stat 4459, 5949–50 (2022).

117. Tolbert & Ammula, supra note 78.

118. Medicaid Enrollment and Unwinding Tracker, KFF (Mar. 27, 2026), https://www.kff.org/report-section/medicaid-enrollment-and-unwinding-tracker-unwinding-data-archived/ [https://perma.cc/LT4F-EZVP]. Evidence indicates that “hundreds of thousands of people disenrolled in the first few months of the unwinding were removed from the program illegally,” though the federal government made efforts to rectify the problem. Spencer Headworth, Stategraft in Public Assistance Programs, 2024 Wis. L. Rev. 503, 528. For an argument that the Biden Administration generally did a decent job with the administrative tools available to it in softening the effects of the unwinding, see Michael K. Gusmano & Frank J. Thompson, Medicaid and the Great Unwinding: The Administrative Presidency Meets Federalism, 50 J. Health Pol., Pol’y & L. 801, 825 (2025).

119. See Drew Gonshorowski, Medicaid Unwinding Drove 77 Percent of Increased Exchange Plan Selections in 2024, Paragon Health Inst. (May 22, 2024), https://paragoninstitute.org/paragon-pic/medicaid-unwinding-drove-77-percent-of-increased-exchange-plan-selections-in-2024/ [https://perma.cc/5E5L-NQVZ].

120. Drishti Pillai & Samantha Artiga, Recent Trump Administration Policies That Impact Health Coverage and Care for Immigrant Families, KFF (Oct. 8, 2025), https://www.kff.org/immigrant-health/recent-trump-administration-policies-that-impact-health-coverage-and-care-for-immigrant-families/ [https://perma.cc/H627-6APN].

121. See Choi, supra note 3.

122. See Nathaniel Weixel, GOP Faces ‘Big, Beautiful’ Blowback Risk on ObamaCare Subsidy Cuts, The Hill (July 8, 2025, at 17:59 ET), https://thehill.com/policy/healthcare/5390885-republicans-obamacare-subsidies-expiration/ [https://perma.cc/68NY-LE6V].

123. See Julie Appleby, States Brace for Reversal of Obamacare Coverage Gains Under Trump’s Budget Bill, KFF Health News (July 3, 2025), https://kffhealthnews.org/news/article/affordable-care-act-aca-obamacare-coverage-gains-threatened-1bbb-uninsurance/ [https://perma.cc/B7LJ-F4HE].

124. See Cong. Budget Off., 61570, Estimated Budgetary Effects of Public Law 119-21, To Provide for Reconciliation Pursuant to Title II of H. Con. Res. 14, Relative to CBO’s January 2025 Baseline (2025), https://www.cbo.gov/publication/61570 [https://perma.cc/8FCC-PZSM].

125. Timothy McBride, Big Bill: Largest Retraction of Health Insurance Coverage in U.S. History, Timothy’s Substack (July 3, 2025), https://timothymcbride.substack.com/p/big-bill-largest-retraction-of-health [https://perma.cc/PH4S-6NUE].

126. Id.

127. See, e.g., Jacob S. Hacker, The Divided Welfare State: The Battle over Public and Private Social Benefits in the United States 9 (2002) (“It is now commonplace to claim that large-scale government programs gain constituencies and condition popular expectations, making them difficult to dismantle or reform.”). In the specific context of threats to roll back existing benefits, see Suzanne Mettler, Lawrence R. Jacobs & Ling Zhu, Policy Threat, Partisanship, and the Case of the Affordable Care Act, 117 Am. Pol. Sci. Rev. 296, 302–308 (2023); Michael W. Sances & Joshua D. Clinton, Policy Effects, Partisanship, and Elections: How Medicaid Expansion Affected Public Opinion Toward the Affordable Care Act, 83 J. Pol. 498, 510–11 (2021).

128. See supra notes 16–18 and accompanying text; see also Hertel-Fernandez, supra note 20, at 13 (“[U]niversal programs tend to build stronger political interest and voice among their beneficiaries than do heavily targeted or means-tested benefits. Yet this does not mean that targeted programs can never produce feedback loops in the mass public.”).

129. Sam Rosenfeld & Daniel Schlozman, The Democrats’ Big—And Failed—Bet, Democracy: J. Ideas (2025), https://democracyjournal.org/magazine/75/the-democrats-big-and-failed-bet/ [https://perma.cc/HX3H-YAKQ] (“Biden-era Democrats have hardly been in denial about the challenge of class dealignment. Ambitious and progressive economic measures to remake markets, they believed, could simultaneously shift politics back to material questions and, through what political scientists term “policy feedback,” win back the allegiance of wayward working-class voters.”).

130. See id. (“This was hardly a far-fetched or unserious theory. But as a political bet, it didn’t pay off. In a bitter lesson for liberal technocrats’ ambitions, the attempt to make electoral hay out of well-designed policy alone must be counted as a failure.”).

131. See supra text accompanying notes 121–26.

132. See infra text accompanying notes 182–86.

133. See Frances Fox Piven & Richard A. Cloward, The New Class War: Reagan’s Attack on the Welfare State and Its Consequences 26–32 (1982); see also Thomas W. Volscho, Neoliberalism, Piven and Cloward’s Bargaining Theory, and Wages in the United States, 1965-2006, 39 J. Socio. & Soc. Welfare 55, 56 (2012) (elaborating and updating Piven and Cloward’s arguments).

134. . Piven & Cloward, supra note 133, at 26.

135. . Daniel Raventós, Basic Income: The Material Conditions of Freedom 73 (2007).

136. . Id. at 23. For other advocates of UBI and similar policies making similar points, see Nick Srnicek & Alex Williams, Inventing the Future: Postcapitalism and a World Without Work 120 (2015) (arguing that under a basic income policy, “by eliminating the reliance on wage labour, workers gain control over how much labour to supply, giving them significant power in the labour market”); Philippe van Parijs & Yannick Vanderborght, Basic Income: A Radical Proposal for a Free Society and a Sane Economy 22 (2017) (“An obligation-free income facilitates saying ‘no’ to jobs that pay little and are unattractive.”); Fred Block & Jeff Manza, Could We End Poverty in a Postindustrial Society? The Case for a Progressive Negative Income Tax, 25 Pol. & Soc’y 473, 496 (1997) (“But the largest economic benefit would come from having a more balanced labor market in which the bargaining position of low-wage employees would be enhanced. Employers would be under pressure to create training and advancement opportunities for low-wage employees, and this would generate continuous improvements in human capital. Employers would also have stronger incentives to invest in new equipment that would eliminate the most dangerous and degraded types of work. The tighter labor market provided by the NIT would encourage employers to shift from low value-added to high value-added production.”); Philip Pettit, A Republican Right to Basic Income?, Basic Income Stud., Dec. 2007, at 1, 5 (arguing that a right to a basic income “would mean that people had adequate income for functioning properly in society. And that income would mean that people would not have to beg the favour of the powerful, or even of the counter-clerk”); Robert S. Taylor, Delaboring Republicanism, 33 Pub. Affs. Q. 265, 268 (2019) (arguing that demogrants empower citizens “to select any kind of workplace environment they prefer, whether by creating one, joining one, or leaving one”); see also Nicolas Bueno, Freedom at, Through, and from Work: Rethinking Labour Rights, 160 Int’l Lab. Rev. 311, 322 (2021) (“In the republican accounts of non-domination, a basic income reduces domination by reducing the costs of exiting a work relationship. Outside republican non-domination theories, a universal basic income is presented as a tool to enable people to gain control of the pace and intensity of their work and to liberate those who conduct work that is mainly meaningless to them. Lastly, other scholars have discussed how a universal basic income could expand the freedom to choose meaningful activities that enable greater self-fulfilment and therefore enhance the positive aspect of freedom from work.” (citations omitted)).

137. Carole Pateman, Democratizing Citizenship: Some Advantages to Basic Income, in Redesigning Distribution: Basic Income and Stakeholder Grants as Alternative Cornerstones for a More Egalitarian Capitalism 83, 90 (Erik Olin Wright ed., 2003).

138. Erik Olin Wright, Basic Income, Stakeholder Grants, and Class Analysis, in Redesigning Distribution: Basic Income and Stakeholder Grants as Alternative Cornerstones for a More Egalitarian Capitalism, supra note 137, at 75, 77.

139. See, e.g., Maury Gittleman, The “Great Resignation” in Perspective, Monthly Lab. Rev. (July 2022), https://www.bls.gov/opub/mlr/2022/article/the-great-resignation-in-perspective.htm [https://perma.cc/7PW3-KGF2] (“Over the last year, the rate of job quitting in the United States has reached highs not seen since the start of the U.S. Bureau of Labor Statistics Job Openings and Labor Turnover Survey program in December 2000.”).

140. Miriam F. Weismann, How the “Great Resignation” and COVID Unemployment Have Eroded the Employer Sponsored Insurance Model and Access to Healthcare, 49 Am. J.L. & Med. 415, 423 (2023).

141. See, e.g., Steven Greenhouse, ‘Striketober’ Is Showing Workers’ Rising Power—but Will It Lead to Lasting Change?, The Guardian (Oct. 23, 2021, at 03:00 ET), https://www.theguardian.com/us-news/2021/oct/23/striketober-unions-strikes-workers-lasting-change [https://perma.cc/YXZ4-L8SR].

142. See, e.g., Kim Parker & Juliana Menasce Horowitz, Majority of Workers Who Quit a Job in 2021 Cite Low Pay, No Opportunities for Advancement, Feeling Disrespected, Pew Rsch. Ctr. (Mar. 9, 2022), https://www.pewresearch.org/short-reads/2022/03/09/majority-of-workers-who-quit-a-job-in-2021-cite-low-pay-no-opportunities-for-advancement-feeling-disrespected/ [https://perma.cc/7RXR-9QD4].

143. See, e.g., Kate Morgan, The Great Resignation: How Employers Drove Workers to Quit, BBC (July 1, 2021), https://www.bbc.com/worklife/article/20210629-the-great-resignation-how-employers-drove-workers-to-quit [https://perma.cc/9RZ7-FV73].

144. See Joseph Fuller & William Kerr, The Great Resignation Didn’t Start with the Pandemic, Harv. Bus. Rev. (Mar. 23, 2022), https://hbr.org/2022/03/the-great-resignation-didnt-start-with-the-pandemic [https://perma.cc/U2YQ-FVSN].

145. See, e.g., Gittleman, supra note 139; Morgan, supra note 143.

146. Fuller & Kerr, supra note 144.

147. See Timothy J. Richards & Zachariah Rutledge, Food System Labor and Bargaining Power, Food Pol’y, Aug. 2023, at, 1, 3, 12.

148. See Tovia Smith, Hotels and Restaurants That Survived Pandemic Face New Challenge: Staffing Shortages, NPR (May 5, 2021, at 08:53 ET), https://www.npr.org/2021/05/05/993433235/hotels-and-restaurants-that-survived-pandemic-face-new-challenge-staffing-shorta [https://perma.cc/G95F-DTBE].

149. Unemployment Insurance During COVID-19: The CARES Act and the Role of Unemployment Insurance During the Pandemic, Hearing Before the S. Comm. on Fin., 116th Cong. 54 (2020) [hereinafter Neilly] (statement of Les Neilly); Press Release, FDA, FDA Approves First COVID-19 Vaccine (Aug. 23, 2021), https://www.fda.gov/news-events/press-announcements/fda-approves-first-covid-19-vaccine [https://perma.cc/TF3Z-RH2N]; NFIB Member Testifies Before U.S. Senate Finance Committee on Impact of Unemployment Insurance on his Small Business, NFIB (June 11, 2024), https://www.nfib.com/news/news/nfib-member-testifies-before-u-s-senate-finance-committee-on-impact-of-unemployment-insurance-on-his-small-business/ [https://perma.cc/DL2P-7D52].

150. Neilly, supra note 149, at 55; see also Jennifer C. Pan, Selling Social Justice: Why the Rich Love Antiracism 25 (2025) (noting that “executives at Bank of America, which had committed $1.25 billion to racial equity programs in 2020, later fretted in a memo that the tightening post-pandemic labor market appeared to be affording workers a little too much leverage”).

151. Michael Kalecki, Political Aspects of Full Employment, 14 Pol. Q. 322, 326, 329–30 (1943).

152. Id. at 329–30.

153. Id. at 326.

154. Id.

155. Id. at 329–30.

156. See id. at 330; see also Block & Manza, supra note 136, at 479 (“While there are many explanations for the failure to legislate tight labor markets during peacetime, the resistance of employers looms very large. Tight labor markets mean that firms may not be able to fill certain vacancies, while the bargaining position of all employees will be considerably improved. If employers might have no choice but to accept these conditions during wartime, they have had enough clout to block such policies during peacetime.”).

157. . Piven & Cloward, supra note 133, at 13 (emphasis omitted); see also Fred Block, Political Choice and the Multiple “Logics” of Capital, 15 Theory & Soc’y 175, 186 (1986) (“The business community tends to oppose redistributive social policies and higher taxes for very simple reasons. Redistributive policies can improve the bargaining power of certain sectors of the labor force with a possible negative effect on profit levels.”).

158. See supra text accompanying notes 139–50.

159. Cf. Mark Barenberg, The Political Economy of the Wagner Act: Power, Symbol, and Workplace Cooperation, 106 Harv. L. Rev. 1379, 1396–97 (1993) (explaining why the business lobby could not stop enactment of the National Labor Relations Act during the depths of the Great Depression).

160. See Patashnik, supra note 11, at 174.

161. See supra text accompanying notes 127–28.

162. See supra text accompanying notes 148–50. For an outstanding discussion of the origins and persistence of the notion of the “poor,” see Katz, supra note 26, at 4–5.

163. Cf. Schneider & Ingram, supra note 14, at 336 (arguing that the understanding of a social program’s target population is often subject to political contestation).

164. See supra text accompanying notes 148–50.

165. See Jerry L. Mashaw, Unemployment Compensation: Continuity, Change, and the Prospects for Reform, 29 U. Mich. J.L. Reform 1, 2 (1996) (“Today’s unemployment compensation system was designed as the answer to a particular question—how to maintain income security and consumer purchasing power during economically induced short-term unemployment.”). Despite this widespread understanding, unemployment insurance has always been designed at least in part to encourage laid-off workers to take jobs that are a good match for their skills and experience, rather than simply the first job that comes along. See Brian Galle, How to Save Unemployment Insurance, 50 Ariz. St. L.J. 1009, 1021–22 (2018) (“UI benefits allow workers to spend longer searching for jobs that are the best match for their skills.”); Lester, supra note 61, at 343 (“Finally, the program was intended to optimize workers’ ability to find jobs that fully utilize their skills and experience, thus preventing skill erosion and tapping labor power as fully as possible. While the payment of a weekly benefit might delay a recipient’s return to work, the reason for that delay would not necessarily be because the worker preferred leisure, even at a reduced income, to work. The delay would also, in theory, give him an opportunity to engage in a more rigorous job search. Rather than having to take the first job that came along just in order to make ends meet, the worker could hold out for a job better matched to his skills and training. Optimizing job matches upon reemployment would also, in theory, minimize career interruptions. Moreover, UI made it easier for at least short-term laid off workers to remain in the area in the event that rehiring would be possible upon recovery. Productivity gains through workforce retention were seen to offset the concomitant dampening of worker mobility.” (footnotes omitted)).

166. Alexander Hertel-Fernandez, Beyond Deliverism, Democracy: J. Ideas (2025), https://democracyjournal.org/magazine/76/beyond-deliverism/ [https://perma.cc/4QFD-2CGF].

167. Id.

168. Personal Responsibility and Work Opportunity Reconciliation Act of 1996, Pub. L. No. 104-193, § 101, 110 Stat. 2105, 2112.

169. Id. § 103 (codified as 42 U.S.C. §§ 601–619).

170. See 42 U.S.C. §§ 602(a)(1)(A), 607(c)–(e), 608(7)(A).

171. E.g., H.R. Rep. No. 104-725, at 262 (1996) (Conf. Rep.).

172. In her influential argument, for example, Professor Deborah Stone treats “mutual aid” and “actuarial fairness” as the two distributive principles that compete in American health care policy. See Deborah A. Stone, The Struggle for the Soul of Health Insurance, 18 J. Health Pol., Pol’y & L. 287, 314 (1993).

173. See Sara Rosenbaum & Kathleen A. Maloy, The Law of Unintended Consequences: The 1996 Personal Responsibility and Work Opportunity Reconciliation Act and Its Impact on Medicaid for Families with Children, 60 Ohio St. L.J. 1443, 1453–55 (1999).

174. Thomas L. Greaney, Foreword: Reconceptualizing Medicaid, 45 St. Louis U. L.J. 1, 2–3 (2001).

175. Nat’l Fed’n of Indep. Bus. v. Sebelius, 567 U.S. 519, 583 (2012) (Roberts, C.J.) (plurality opinion).

176. Patashnik & Zelizer, supra note 9, at 1078.

177. See supra text accompanying notes 116–19.

178. Markus Bjoerkheim & Liam Sigaud, The Covid ‘Emergency’ Is All About Medicaid, Wall St. J. (Dec. 18, 2022, at 16:56 ET), https://www.wsj.com/articles/the-covid-emergency-is-all-about-medicaid-pandemic-elderly-insurer-eligibility-enrollment-11671387341? [https://perma.cc/8K39-XRWA].

179. Id.

180. See Tarren Bragdon & Sam Adolphsen, The Covid Medicaid Money Grab, Wall St. J. (Nov. 20, 2022, at 17:16 ET), https://www.wsj.com/articles/covid-medicaid-money-grab-obamacare-health-funding-socialized-medicine-states-governors-11668979145? [https://perma.cc/8F2M-F5PZ].

181. The Battle Over Work and Welfare, Wall St. J. (Dec. 11, 2022, at 15:48 ET), https://www.wsj.com/articles/the-battle-over-work-and-welfare-biden-administration-covid-pandemic-georgia-11670365943? [https://perma.cc/V5XA-RXLB]; see also Biden’s Choose-Your-Own-Covid Pandemic Policy, Wall St. J. (Oct. 14, 2022, at 18:41 ET), https://www.wsj.com/articles/bidens-choose-your-own-pandemic-policy-biden-administration-white-house-health-and-human-services-covid-11665785857? [https://perma.cc/3F7V-9EK4] (“Whether the crisis is over varies by agency and depends on what the White House is trying to accomplish. The HHS extension this week will freeze state Medicaid rolls and prevent ineligible recipients from being removed.”).

182. Robert F. Kennedy, Jr., Mehmet Oz, Brooke Rollins & Scott Turner, Trump Leadership: If You Want Welfare and Can Work, You Must, N.Y. Times (May 14, 2025), https://www.nytimes.com/2025/05/14/opinion/trump-welfare-medicaid-requirements.html? [https://perma.cc/PHS7-QQHV].

183. Speaker Johnson Joins Meet the Press, U.S. Congressman Mike Johnson (June 1, 2025), https://mikejohnson.house.gov/news/documentsingle.aspx?DocumentID=1606 [https://perma.cc/Q953-TP6Y].

184. Id.

185. Arrington Holds Hearing on Rooting Out Waste and Fraud, U.S. Representative Jodey Arrington (June 25, 2025), https://arrington.house.gov/news/documentsingle.aspx?DocumentID=3841 [https://perma.cc/4N28-WRRY].

186. Ryan Warner & Tom Hesse, Rep. Jeff Hurd on Trump’s Big Beautiful Bill: ‘It’s Not Perfect’ but Positives Win Out, CPR News (July 10, 2025, at 16:58 CT), https://www.cpr.org/2025/07/10/interview-jeff-hurd-big-beautiful-bill/ [https://perma.cc/T45K-6TUS].

187. Nat’l Fed’n of Indep. Bus. v. Sebelius, 567 U.S. 519, 583 (2012) (Roberts, C.J.) (plurality opinion).

188. See, e.g., Hertel-Fernandez, supra note 166 (“Facing this hostile media landscape, the Administration ultimately decided to cede the narrative battle. Instead of countering narratives around labor shortages and outsized fraud, President Biden gave widely covered remarks describing steps the Department of Labor was taking to encourage workers to take available jobs. Even though research at the time had found that extended UI benefits were not major contributors to labor shortages, the Administration gave into the frame centered on fraud and shirking.”).

189. Id.; see also Michener, supra note 20, at 16 (arguing that the evanescence of the COVID CTC expansion “points to the limits of simply expanding policy benefits to include positively constructed and ostensibly more powerful target populations (e.g., ‘the middle class’) in hopes that such groups might affirmatively influence the destiny of a policy. The political potential of such expansions is unlikely to materialize in the absence of strategic efforts among civil society and movement groups to mobilize and organize the populations that benefit from policy”).

190. David Dagan & Steven M. Teles, The Social Construction of Policy Feedback: Incarceration, Conservatism, and Ideological Change, 29 Stud. Am. Pol. Dev. 127, 128 (2015).

191. See supra note 31 and accompanying text. It is also consistent with survey research demonstrating that the public often has stigmatized views of recipients of some universal programs. See Thomas Gift & Carlos X. Lastra-Anadón, “Deservingness” and Public Support for Universal Public Goods: A Survey Experiment, 87 Pub. Op. Q. 44, 45, 47 (2023); Catherine C. Thomas et al., Mitigating Welfare-Related Prejudice and Partisanship Among U.S. Conservatives with Moral Reframing of a Universal Basic Income Policy, J. Exp. Soc. Psych., Mar. 2023, at 1, 13; cf. Jennifer Sykes et al., Dignity and Dreams: What the Earned Income Tax Credit (EITC) Means to Low-Income Families, 80 Am. Socio. Rev. 243, 244, 257 (2015) (arguing that, although the EITC is a means-tested program, it has a less stigmatizing and more inclusionary social meaning than other targeted benefits programs).

192. . Frank R. Baumgartner & Bryan D. Jones, Agendas and Instability in American Politics 4 (2d ed. 2009).

193. . Paul Pierson, Politics in Time: History, Institutions, and Social Analysis 134–35 (2004).

194. Giovanni Capoccia & R. Daniel Keleman, The Study of Critical Junctures: Theory, Narrative, and Counterfactuals in Historical Institutionalism, 59 World Pol. 341, 343 (2007).

195. Michener, supra note 20, at 13.

196. Id. at 3, 13–14; see also Hertel-Fernandez, supra note 166 (making a similar argument about Biden-era initiatives); Rosenfeld & Schlozman, supra note 129 (same).

197. Michener, supra note 20, at 16.

198. Alex Gourevitch & Lucas Stanczyk, The Basic Income Illusion, Catalyst, Winter 2018, at 151, 153–54.

199. Id. at 170.

200. Id.

201. See, e.g., Steven Greenhouse, Beaten Down, Worked Up: The Past, Present, and Future of American Labor 9, 78 (2019) (noting that “[u]nions . . . played a pivotal role in winning enactment of the federal minimum wage, Social Security, unemployment insurance, Medicare, occupational safety laws, and the civil rights laws of the 1960s”); Hammond, Kleiman & Scheffler, supra note 1, at 367.

202. See, e.g., Erik Loomis, Biden’s Labor Report Card: Historian Gives ‘Union Joe’ a Higher Grade Than Any President Since FDR, The Conversation (May 16, 2024, at 08:17 ET), https://theconversation.com/bidens-labor-report-card-historian-gives-union-joe-a-higher-grade-than-any-president-since-fdr-228771 [https://perma.cc/H4SU-W2WQ].

203. See Eleanor Mueller, Congress Thwarted Biden on Unions. Or Did It?, POLITICO (June 21, 2022, at 18:30 ET), https://www.politico.com/news/2022/06/21/how-biden-shifted-labor-law-00040317 [https://perma.cc/J8HF-YSFG].

204. See Christopher Adinolfi, Can Private Sector Unionization Be Saved?: An Analysis of the PRO Act as a Model for Effective NLRA Reform, 90 Fordham L. Rev. 103, 132 (2021).

205. This point is a key theme of Jacob S. Hacker & Paul Pierson, Policy Feedback in an Age of Polarization, Annals, Sep. 2019, at 8, 16–17, 19–20.