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lite.cnn.com - on gopher - inofficial | |
ARTICLE VIEW: | |
Republicans want to add work requirements to Medicaid. Even some | |
recipients with jobs are concerned | |
By Tami Luhby, CNN | |
Updated: | |
6:56 PM EDT, Tue July 1, 2025 | |
Source: CNN | |
Without , Joanna Parker would have a much tougher time holding down a | |
job. | |
The Garner, North Carolina, resident works for a local home goods store | |
up to 20 hours a week, typically. But she also suffers from | |
degenerative disc disease in her spine and relies on Medicaid to cover | |
her doctor’s visits, physical therapy and medication that helps her | |
manage the pain so she can get out of bed in the morning. | |
“If I lose my insurance, I lose my ability to work,” said Parker, | |
40, who was uninsured for about a decade until North Carolina to | |
low-income adults in December 2023. | |
That’s why Parker is so worried about the sweeping Republican that | |
the Senate narrowly approved on Tuesday. The bill, which passed the | |
House by a slim margin in May, would impose the first-ever work | |
requirement on Medicaid enrollees like her. Lawmakers hope to send the | |
legislation, which aims to fulfill ’s agenda, to his desk before July | |
4th. | |
Though she’s employed, Parker fears she could be stripped of her | |
health insurance if she’s not able to work enough hours every month | |
or gets tripped up in reporting her time on the job to the state – | |
should the work mandate become law. She is now facing the potential | |
need for a biopsy so she’s even more worried that she could be left | |
without insurance. | |
“I feel it will be so easy to lose your coverage if you do the | |
reporting the wrong way and you can’t fix it,” said Parker, who has | |
applied for full-time jobs over the past 18 months but said she | |
hasn’t received responses. | |
The Senate GOP’s “big, beautiful bill” would mandate that many | |
Medicaid expansion enrollees ages 19 to 64 work, volunteer, go to | |
school or participate in a job training program at least 80 hours a | |
month to obtain or maintain coverage. The requirement, which would go | |
into effect by the end of 2026, would not apply to parents with | |
children under age 14, pregnant women, medically frail individuals and | |
those with substance-abuse disorders, among others. (The House version | |
would exempt all parents with dependent children.) | |
The provision would help achieve Republicans’ longstanding goal of | |
introducing work requirements into Medicaid. It’s part of an that GOP | |
lawmakers would make to the nation’s safety net program. | |
Proponents say the mandate would prompt enrollees who could – and | |
should, in supporters’ view – work to get jobs and, eventually, | |
move off of Medicaid. Also, they argue, it would preserve the program | |
for the most vulnerable Americans and reduce spending on the low-income | |
adults who gained coverage through the Affordable Care Act’s | |
expansion provision, a frequent target of congressional Republicans. | |
“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, which | |
promotes work requirements in government assistance programs. | |
But many Medicaid enrollees and their advocates fear millions of people | |
would lose their coverage under the proposed measure, including many | |
who already work or qualify for an exemption but would get stuck in red | |
tape. | |
An estimated 5.2 million Medicaid recipients would lose their coverage | |
over 10 years because of the work mandate, and few would have access to | |
job-based insurance, according to a Congressional Budget Office | |
analysis of the House bill. Overall, the legislation would leave nearly | |
11 million more people uninsured in 2034, according to CBO. | |
CBO has not released a detailed breakdown of the impact of the bill | |
passed by the Senate, but a preliminary estimate from Sunday found that | |
it would result in being uninsured in 2034. (The final version of the | |
bill included a change that would likely reduce the number of uninsured | |
by more than 1 million people.) | |
On Medicaid and working | |
Many adults with Medicaid coverage have jobs, though the estimates | |
vary. | |
Some 38% of adult enrollees had full-time jobs in 2023, most of them | |
for the full year, according to KFF, a nonpartisan health policy | |
research group that looked at folks ages 19 to 64 without dependent | |
children who did not receive disability benefits or have Medicare | |
coverage, which insures people with disabilities. Just over 20% worked | |
part time, up to 35 hours a week. | |
Another 31% reported that they did not work because they were | |
caregivers or in school or had an illness or disability, all of which | |
might qualify them for exemptions from the work requirements under the | |
House bill. | |
Only 12% of the enrollees said they were not working because they | |
couldn’t find jobs, had retired or reported another reason, according | |
to the KFF analysis, which is based on US Census Bureau data. | |
“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. “But people have a lot of difficulty navigating the | |
process for reporting their exemptions, or if they’re not exempt, | |
reporting their work activities.” | |
He pointed to Arkansas, the first state to temporarily during Trump’s | |
first term before the effort was . More than 18,000 Medicaid enrollees | |
over several months – even though the state automatically exempted | |
about two-thirds of those subject to the mandate. | |
Many beneficiaries in Arkansas did not understand the work requirements | |
or did not realize it applied to them, a found. Participants tend to | |
move frequently so their contact information may have been outdated. | |
Others had difficulty using the online reporting portal, especially if | |
they did not have access to computers and internet service. | |
“That population has all kinds of challenges with interacting with a | |
system like that,” said Bill Kopsky, executive director of the | |
Arkansas Public Policy Panel, a social and economic justice advocacy | |
group. He noted that many enrollees didn’t receive mailed | |
notifications from the state or didn’t realize they had to take | |
action. | |
What’s more, the mandate was not associated with an increase in | |
employment, though the uninsured rate did rise among low-income | |
residents in the affected age group, said Karpman, who analyzed Census | |
data in a . That finding is in line with a from Harvard University | |
researchers, which was based on telephone surveys. | |
Ingram, however, challenges the assertion that the effort did not spur | |
Medicaid recipients to find work. He noted in a that more than 9,000 | |
enrollees found jobs during the time the work requirement was | |
implemented. Some 99% of them were in the age group subject to the | |
mandate, according to a that cited state data. | |
Can’t afford to lose Medicaid again | |
Katrina Falkner knows what it’s like to be stuck in a Medicaid | |
paperwork morass. The Chicago resident, who cares for her elderly | |
father and other family members with disabilities, said she was | |
disenrolled from the program in 2023 after the state Department of | |
Human Services lost the paperwork that she had spent days organizing. | |
The agency told her that it reinstated her, she said. But when she went | |
to the hospital, she found out she was still uninsured. It took several | |
visits to multiple agency offices before the issue was resolved the | |
following year. | |
The department told CNN that such scenarios are “extremely rare” | |
and it works to “ensure timely review and enrollment” for all | |
applicants eligible for Medicaid. | |
Falkner, 43, volunteers with several community organizing groups at | |
least 20 hours a week and works every other Saturday as a Head Start | |
ambassador for the Chicago Early Learning program. She also suffers | |
from asthma, anemia, vertigo and other conditions, which can make it | |
hard for her to work or volunteer at times. Being able to meet the | |
reporting requirements concerns her, especially since her electricity | |
and internet access are sometimes cut off. | |
“If I lost my Medicaid, it would cause me a whole lot of | |
struggles,” she said, noting that the program covers her nebulizer | |
and other health care needs. “If they don’t have the right | |
documents, I won’t be able to be in existence because I can’t | |
breathe.” | |
Although Dana Bango of Zionville, North Carolina, has dealt with state | |
social service agencies for years, she still “sweats it every | |
time.” There are many strict deadlines and hoops to jump through, so | |
she has to remain vigilant, she said. | |
The potential work mandate fills her with “dread” since she’s | |
worried that she could fall through the cracks and lose her Medicaid | |
coverage – even though she works 20 hours a week at the North | |
Carolina Christmas Tree Association and delivers for Door Dash 10 hours | |
a week. | |
A cancer survivor who still needs follow up care, Bango, 57, is | |
concerned that she may not get the help she could need from state | |
workers to log her hours if the mandate takes effect. | |
“I’ve been uninsured before. I don’t want to go back there. | |
It’s a scary thing,” she said. “This adds more stress, which will | |
lead to more health issues. It’s not good for low-income working | |
people like us.” | |
This story has been updated with additional developments. | |
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