Without Medicaid, Joanna Parker would face a significant challenge in maintaining her job. The resident of Garner, North Carolina, works up to 20 hours a week at a local home goods store. However, she suffers from degenerative disc disease and depends on Medicaid for her medical needs, which include doctor visits, physical therapy, and medication to manage her pain. “If I lose my insurance, I lose my ability to work,” said Parker, 40, who only gained coverage after North Carolina expanded Medicaid to low-income adults in December 2023.
Parker’s concerns are echoed by many as the Senate narrowly approved a Republican tax and spending cuts package on Tuesday. This legislation, which passed the House in May, aims to introduce the first-ever work requirement for Medicaid enrollees. Lawmakers are pushing to have the bill on President Donald Trump’s desk by July 4th. Although Parker is employed, she fears losing her health insurance if she cannot meet the required work hours or if she encounters issues in reporting her work time to the state.
Potential Impact of Medicaid Work Requirements
The proposed legislation mandates that Medicaid expansion enrollees aged 19 to 64 must work, volunteer, attend school, or participate in a job training program for at least 80 hours a month to maintain their coverage. Exemptions include parents with children under 14, pregnant women, medically frail individuals, and those with substance-abuse disorders. The House version of the bill would exempt all parents with dependent children.
This move represents a significant shift in Medicaid policy, aligning with the Republican goal of integrating work requirements into the program. Proponents argue that this will encourage capable enrollees to find employment and eventually transition off Medicaid, thereby preserving resources for the most vulnerable and reducing spending on low-income adults who gained coverage through the Affordable Care Act’s expansion provision.
“If you are an able-bodied adult and there’s no expectation of you to work or train or volunteer in any way, there’s going to be a large number who don’t,” said Jonathan Ingram, vice president of policy and research at the Foundation for Government Accountability.
Concerns and Challenges
Despite the intentions behind the policy, many Medicaid recipients and advocates express concern that millions could lose their coverage, including those who already work or qualify for exemptions but may get entangled in bureaucratic hurdles. The Congressional Budget Office (CBO) estimates that 5.2 million Medicaid recipients could lose their coverage over a decade due to the work mandate, with few having access to job-based insurance.
Overall, the legislation could result in nearly 11 million more people being uninsured by 2034, according to CBO projections. A preliminary estimate of the Senate bill suggests that nearly 12 million more people could be uninsured by 2034, although a recent amendment may reduce this number by over 1 million.
Historical Parallels and Expert Opinions
Many adults with Medicaid coverage are already employed. According to KFF, a nonpartisan health policy research group, 38% of adult enrollees had full-time jobs in 2023, while over 20% worked part-time. Another 31% were caregivers, students, or had health issues that might exempt them from work requirements under the House bill.
“Most people are doing the things that they’re expected to do in terms of qualifying activities or things that could qualify them for an exemption,” said Michael Karpman, principal research associate at the Urban Institute.
Karpman highlighted the challenges faced by Arkansas, the first state to temporarily implement work requirements during Trump’s first term. More than 18,000 Medicaid enrollees lost coverage due to confusion and difficulties in navigating the reporting process, despite automatic exemptions for many.
Bill Kopsky, executive director of the Arkansas Public Policy Panel, noted that many enrollees did not receive notifications or understand the requirements, leading to coverage loss without any significant increase in employment rates.
Real-Life Implications
Katrina Falkner, a Chicago resident, experienced the complexities of Medicaid paperwork firsthand. After being disenrolled due to a paperwork error, she faced numerous challenges to regain her coverage. She volunteers extensively and works part-time, but worries about meeting reporting requirements due to unreliable internet access.
“If I lost my Medicaid, it would cause me a whole lot of struggles,” Falkner said, emphasizing the importance of the program for her health needs.
Similarly, Dana Bango from Zionville, North Carolina, fears losing her Medicaid coverage despite working multiple jobs. As a cancer survivor, she requires ongoing medical care and is concerned about the additional stress and health issues that could arise from the work mandate.
The debate over Medicaid work requirements continues to unfold, with significant implications for millions of Americans relying on the program. As lawmakers push forward with the legislation, the potential consequences for recipients like Parker, Falkner, and Bango remain a critical concern.