The Systems View: How Work Requirements Create Unpredictable Outcomes
Work requirements create feedback loops where documentation and compliance pressures amplify complexity, shift focus to short-term fixes, and deepen instability for those most in need.
Work requirements consistently generate instability as access to care becomes dependent on flawless navigation of documentation, exemptions, and verification systems. As these interacting pressures create churn, organizations shift focus from long-term support toward short-term compliance, and people who most need stability face the highest barriers. The result is a system that keeps trying to fix complexity with more complexity, intending to promote work and health, yet repeatedly producing the opposite.
Systems thinking shows that work requirements create feedback loops where coverage, health, employment, and administrative processes continually shape one another. Added verification rules may increase accuracy but can also raise confusion, leading to more missed deadlines and further adjustments. Coordination among employers, insurers, providers, and community organizations can improve navigation, while siloed actions can create barriers that reinforce non-compliance. At the same time, what programs choose to measure, typically documentation success rather than actual work circumstances, influences which outcomes are prioritized and how performance is interpreted. State decisions also reflect differing incentives tied to budgets, administrative capacity, and policy goals, resulting in varied approaches and outcomes even under similar requirements.
Complex systems adapt, but the direction of adaptation is uncertain. Work requirements could drive gains in efficiency through better technology and coordination, or widen gaps as people with fewer resources face compliance challenges. They may increase monitoring while also expanding community support, though neither result is guaranteed. Most likely, the system will evolve unevenly with some improvements, continued strain, and periodic adjustments rather than a definitive shift in one direction.
Explore Syam Adusimilli’s perspective on these dynamics and how the industry can best adapt to meet the transformative potential of The One Big Beautiful Bill (OB3).
