Republicans in Washington are currently considering substantial cuts to Medicaid, which could impact medical coverage for approximately 80 million individuals across the U.S. who depend on this essential safety net program. During the Biden administration, there was an increase in enrollment in federally funded healthcare programs such as Medicaid and the Affordable Care Act (ACA) marketplace, a development that Democrats view as a significant achievement.
As the GOP works to reduce federal expenditures and enact generous tax reductions for corporations and wealthier citizens, Medicaid has emerged as a target for funding reductions. The Medicaid program, totaling around $880 billion, sees a majority of its funding coming from federal taxpayers, with some states shouldering up to 80% of the costs. States have also expressed challenges in financing the rapid growth of their Medicaid populations and the increased health needs of enrollees.
In an effort to cut costs, Republicans who control Congress are contemplating implementing work requirements for Medicaid recipients. They are also looking at the possibility of transitioning to a reduced, fixed reimbursement rate for states. This could lead to billions of dollars being redirected away from affordable healthcare that supports the low-income population over the next ten years.
Prior to Congress’s consideration of these changes, Republican governors from states like Arkansas, Ohio, and South Dakota began proposing their own Medicaid work requirements, which they anticipate will receive approval from the Trump administration. Additionally, the Republican leadership has also proposed a drastic reduction in funding for the ACA’s navigator program, which has previously aided many in enrolling in both ACA and Medicaid coverage. The proposal would slash the annual budget for navigators by 90%, cutting it down to just $10 million.
Speaker Mike Johnson of Louisiana has hinted at linking work to Medicaid access. He expressed, “It’s common sense. Little things like that make a big difference not only in the budgeting process but in the morale of the people. You know, work is good for you. You find dignity in work.” However, data from KFF suggests that 92% of Medicaid participants are already engaged in work, schooling, or caregiving activities.
Republicans are proposing work requirements similar to those of the Supplemental Nutrition Assistance Program (SNAP), which mandates able-bodied individuals aged 16 to 59 to work or volunteer for a minimum of 80 hours a month unless they meet certain exemptions. On average, participants of SNAP report a monthly household income of approximately $852, with benefits averaging $239.
During a recent retreat for House Republicans at Trump’s golf resort, there was sentiment among party members that imposing work requirements could encourage individuals to seek jobs that offer health insurance. Congressman Darrell Issa from California emphasized that budget cuts shouldn’t negatively influence the most vulnerable but rather target misuse of benefits.
Another suggestion involves converting federal reimbursements into a per-person limit, which would likely shift costs onto states, forcing them to make difficult decisions regarding coverage. Joan Alker, head of the Georgetown Center for Children and Families, noted, “People still have health care needs even if you cut their coverage.”
Any potential reductions to Medicaid may face significant backlash, given that over half of U.S. adults believe the government underfunds Medicaid, while only 15% feel it overspends.
Previously, the Biden administration had largely obstructed states from implementing their own work requirements and required states to eliminate such mandates for Medicaid coverage. Now that Trump is back in power, several states led by Republicans are seeking approval from the Centers for Medicare and Medicaid Services to reinstate these rules. In 2017, Arkansas established a work requirement that resulted in approximately 18,000 individuals losing their coverage. That rule was eventually halted by a federal judge in response to the Biden administration’s policies.
For many, the experience of meeting these requirements can be burdensome. For instance, in Georgia, a resident named Paul Mikell participates in a Medicaid program that mandates work, volunteering, or schooling for access to coverage. He often faces difficulties reporting his hours due to technological issues, describing the process as akin to a struggle on a borrowed computer at a public library.
In Idaho, where state lawmakers are pursuing implementation of new work requirements and limited Medicaid benefits, family doctor Peter Crane reports that many of his patients rely on Medicaid and work in demanding jobs, such as farming and mining. Before Medicaid expansion, countless uninsured patients avoided seeking medical help, sometimes leading to severe health complications. Crane emphasizes that these individuals are hard-working members of society who actively contribute to the economy.
Democrats have raised alarms about the ripple effects of potential cuts on healthcare facilities, especially rural hospitals and nursing homes. Hospitals have benefited significantly from Medicaid coverage, which enables them to receive payments for patient care. House Democratic leader Hakeem Jeffries warned on the House floor that cuts could lead to the closure of hospitals across America, adversely affecting vulnerable populations including children, seniors, and individuals with disabilities.
This article has been revised to clarify that the work requirement under consideration would be 80 hours monthly, not weekly.
