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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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