Five Million Could Lose Medicaid Coverage Under Republican Proposals

Up to 5 million Americans stand to lose their public health care coverage should federal work requirements proposed by Republicans be enacted nationwide.

A joint analysis from the Robert Wood Johnson Foundation and the Urban Institute published Monday found that a federal work-requirement policy could result in between 4.6 and 5.2 million of the projected 13.3 million Medicaid expansion enrollees in 2026 losing out on coverage.

Why It Matters

Medicaid is the primary program providing health care to lower income individuals in the U.S., with over 80 million currently enrolled. In the ongoing Congressional budget negotiations, Republicans have struggled to outline a plan which allows for spending reductions and tax breaks while avoiding cuts to one of the nation's most subscribed-to and popular programs—which President Donald Trump promised "wouldn't be touched."

Federal work requirements have been proposed by Republicans at the state and federal level as a way to condition coverage rather than cut it, while reducing government spending in the process. Democrats, however, have long opposed such measures as inconsistent with the program's aims, given the potential administrative burden and the likelihood that many deserving enrollees could lose out on coverage.

What To Know

The first Trump administration encouraged states to incorporate work requirements into Medicaid coverage, but these efforts faced pushback and were struck down by federal judges.

Since Trump's second term began, federal work requirements for nondisabled adults have again been proposed by Congressional Republicans. A draft bill introduced to the House in February included a minimum work requirement for certain adults enrolled in Medicaid, requiring those "who are not otherwise unable to work due to a medical condition, family situation, or other listed reason to work or volunteer at least 20 hours per week" in order to qualify for coverage.

Governors from several states such as South Carolina, Ohio and Arkansas have also proposed introducing similar conditions.

Work requirements have also emerged as a topic of conversation in the ongoing Congressional budget negotiations. This forms part of the GOP's wider push for stricter eligibility requirements and the $880 billion in savings the House Energy and Commerce Committee, which oversees Medicaid, has been instructed to find over the next decade.

The analysis by the Robert Wood Johnson Foundation and the Urban Institute was based on experiences in Arkansas and New Hampshire, states which briefly enacted work requirements. It found that a nationwide rollout of the requirements could mean at least 10,000 adults losing coverage in all 40 expansion states—those which opted to expand Medicaid eligibility under the Affordable Care Act—with losses reaching over 100,000 in 13 of these states.

Potential coverage losses would be largest in highly populated states, according to the researchers, with California (1-1.2 million) and New York (743,000–846,000) seeing the largest drops.

What People Are Saying

The Robert Wood Foundation and Urban Institute wrote in their report: "Though over nine in 10 expansion adults ages 19 to 55 already work, participate in work-related activities, or could meet exemption criteria, many would lose coverage because of low awareness and understanding of the policy and difficulty using state reporting systems."

The Foundation for Government Accountability, in a recent report, said: "Implementing Medicaid work requirements nationwide would save federal taxpayers $260 billion over the next decade.

"Even a modest work requirement would go a long way to help able-bodied adults get back into the workforce, while improving the budgetary outlook of the federal government," the report continued.

House Speaker Mike Johnson told reporters recently: "No one has talked about cutting one benefit in Medicaid to anyone who's duly owed. What we've talked about is returning work requirements so, for example, you don't have able-bodied young men on a program that's designed for single mothers and the elderly and disabled."

What Happens Next?

Last week, Republicans passed a budget resolution which will form the basis for a bill set to be introduced in the coming weeks or months. The framework did not outline specific programs that could be targeted by budgetary cuts. With slim majorities in the House and the Senate, Republicans may hope to steer clear of directly cutting Medicaid to avoid losing support from lawmakers whose reelection prospects could be hurt by such a move.