The Trump administration has announced that it will allow states to impose work requirements on Medicaid recipients. Administration officials portrayed the policy change as an attempt to encourage workforce participation among the poor, characterizing it as a move away from “the soft bigotry of low expectations consistently espoused by the prior administration.”

Nevermind that most Medicaid recipients work already, many holding down two or three jobs in precarious low-wage sectors. Meanwhile, those who don’t work usually can’t, either because there are no jobs available, or because of circumstances that make employment infeasible — like untreated chronic pain, inadequate transportation, or lack of child care. By characterizing Medicaid work requirements as much-needed kick in the butt to unemployed poor people, conservative politicians are recapitulating mythical ideas about welfare reliance — conjuring what Ronald Reagan famously called the “spider’s web of dependency,” which he used to justify his administration’s relentless attacks on social programs.

But conservatives aren’t the only ones to blame for the consistent incursions on Medicaid. Work requirements are only possible, structurally speaking, because Medicaid is a means-tested program to begin with — that is, it targets a specific population with strict criteria and eligibility tests, unlike Social Security (or, theoretically, single-payer health care) which applies automatically to everyone and is therefore universal. Over the decades, many of the architects of means-tested social welfare policy have been liberals — specifically neoliberals.