Congress is considering work rules for the millions of people covered by Medicaid


WASHINGTON — More than half a million of the poorest Americans could lose health insurance under a law passed by the Republican House that would require people to work to get health care through Medicaid.

It’s one of dozens of provisions included in the GOP bill that would allow for an increase in the debt limit but curb government spending over the next decade. The bill is unlikely to become law. It is being used by House Republicans to bring Democrats to the negotiating table and avoid a debt default.

Democrats have strongly opposed Medicaid work requirements, saying they discourage people from working and increase the number of uninsured in the country.

Consider how this proposal would save taxpayers money but leave some Americans wanting access to health care.


The work requirement states that able-bodied adults between the ages of 19 and 55 without children or other dependents must work, study for a job, or perform community service to stay on Medicaid. They had to spend at least 80 hours a month to receive state-sponsored health care coverage.

About 84 million people are enrolled in Medicaid, and the Congressional Budget Office estimates that 15 million are eligible. The Department of Health and Human Services estimates that millions more need to work — about a third of enrollees.


Republicans say the move will push Americans into jobs, allowing them to opt out of government assistance.

The requirements would also be fair to those who work to support their families, said House Majority Leader Steve Scalise, R-La.

“In this tough economy, a single mother working two or three jobs to make ends meet doesn’t want to pay a stay-at-home paycheck,” Scalise said.

Democrats argue that work requirements could also unfairly push people off Medicaid.

In Arkansas, some people were wrongly excluded from Medicaid when the state implemented brief work requirements, Chiquita Brooks-LaSour, administrator of the Centers for Medicare and Medicaid Services, told lawmakers. In some cases, people are not required to work, but have not filled out the necessary documents.

“It’s not just people who comply with the requirements, but they often get caught up in the bureaucracy,” he said. “It’s probably mostly people who have been released.”

About 1 in 4 people who were required to work lost coverage during Arkansas’ 2018 work experience.

Work requirements put a strain on Medicaid enrollees. Although no one has been kicked out of Medicaid in the last three years because of the pandemic, that changed in April when the federal government required states to test the income eligibility of all enrollees to see if they make too much money to qualify for health benefits. .

People who start a job, earn less, or change jobs find that these new incomes will soon require coverage.

Amy Shaw, 39, of Rochester, New Hampshire, lost her family’s Medicaid coverage in April after her husband received a raise from 50 cents to $17 an hour at an auto parts store. Shaw is not subject to the GOP’s job requirements because she has two daughters, but the family’s case shows how modest incomes can push people out of Medicaid coverage and cost them more time.

Suddenly, instead of $3, he was billed $120 for a doctor-ordered cancer screening. In addition, since the beginning of the pandemic, their rent has increased by 40%, food, utilities and other necessities have become more expensive.

“It’s like the system is set up so you don’t want to go back (to work) because you lose more than you win,” Shaw said. “I don’t want to go to this mammogram and colonoscopy. “I don’t even want to go to these meetings because it costs a lot of money.”


It often depends on how many people who have to work decide whether or not to fill out the proper paperwork to be covered.

The Congressional Budget Office estimates the requirements would save $109 billion over the next decade. That savings will come in two ways: About 600,000 people who will be kicked out of Medicaid, and then 900,000 people who will lose federal funding for Medicaid but enroll in the program through their state.

This analysis also says the bill does little to improve employment among Medicaid enrollees.


The House GOP bill will not pass the Democratic-controlled Senate or, as it stands, President Joe Biden will not sign it into law.

But don’t expect work requirements and cuts to Medicaid benefits to go away anytime soon. The number of people enrolled in Medicaid has increased in recent years, increasing by more than 20 million since 2020.

And that’s a good thing if you ask the Democrats — they’ve focused on record-low uninsured rates that will allow more people to access health care. Democratic-led states, for example, proposed new ways to expand Medicaid under the Biden administration, allowing more access to recently released convicts and new mothers.

But Republicans want to cut safety net programs to pre-pandemic levels. Republicans in some states are already pushing for work requirements. Arkansas Gov. Sarah Huckabee Sanders has asked the federal government to approve a proposal that would move anyone who doesn’t meet Medicaid’s work requirements for private insurance into traditional fee-for-service Medicaid.


Associated Press writers Holly Ramer in Concord, New Hampshire, and Kevin Freking and Lisa Mascaro in Washington contributed.

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