Latest news with #workrequirement
New York Times
12 hours ago
- Health
- New York Times
Why a G.O.P. Medicaid Requirement Could Set States Up for Failure
The strict Medicaid work requirement at the center of the Republicans' major policy bill wouldn't just require millions of poor Americans to prove they are employed to sign up for health insurance. It would also require dozens of states to quickly build expensive and complex software systems to measure and track who is eligible. This new responsibility for states, whose existing Medicaid computer systems are often outdated, would be accompanied by reduced federal funding through other changes in the bill. The result, according to state officials, software developers and policy experts, could be major failures in state systems for enrolling people in Medicaid. 'That's how happens,' said Julie Brinn Siegel, a former top Biden administration budget official, referring to the Obama administration's botched launch of the online Affordable Care Act enrollment portal in 2013. Ms. Siegel and others familiar with Medicaid systems envision problems like websites that don't load or incorrectly tell applicants they are not eligible. And Medicaid workers may be overwhelmed as they try to run call centers and process applications. The fallout could mean eligible Americans will have their coverage dropped. Republicans contend that the work requirement achieves twin goals: It ensures that the government directs resources to Americans who are contributing to society, while saving money to help finance an extension of President Trump's tax cuts. Want all of The Times? Subscribe.
CBS News
2 days ago
- Health
- CBS News
Too sick to work, some Americans worry Trump's bill will strip their health insurance
Stephanie Ivory counts on Medicaid to get treated for gastrointestinal conditions and a bulging disc that makes standing or sitting for long periods painful. Her disabilities keep her from working, she said. Ivory, 58, of Columbus, Ohio, believes she would be exempt from a requirement that adult Medicaid recipients work, but she worries about the reporting process. "It's hard enough just renewing Medicaid coverage every six months with the phone calls and paperwork," she said. In Warrenton, Missouri, Denise Sommer hasn't worked in five years and relies on Medicaid to get care for anxiety, high blood pressure, and severe arthritis in her back and knees. Sommer, 58, assumes she could easily qualify for an exemption with a doctor's note. "There's too much abuse in the system," she said. She added that she doesn't worry about others losing coverage for failing to meet reporting requirements. "That's their own fault, because they should just keep their address updated with the state and read their mail," she said. President Trump's One Big Beautiful Bill Act, sprawling legislation to extend his tax cuts and enact much of his domestic agenda, would require 40 states and the District of Columbia, all of which expanded Medicaid, to add a work requirement to the program. Enrollees would have to regularly file paperwork proving that they are working, volunteering, or attending school at least 80 hours a month, or that they qualify for an exemption. Many Republicans say nondisabled adults should not be on Medicaid, arguing the work requirement will incentivize more people to get jobs. House Speaker Mike Johnson has said it would help preserve Medicaid "for people who rightly deserve" coverage, "not for 29-year-old males sitting on their couches playing video games." Last month, Johnson claimed 4.8 million Medicaid enrollees are choosing not to work, a figure disputed by health policy experts. Spokespeople for Johnson did not respond to a request for comment. Studies by the Urban Institute and KFF show that, among working-age enrollees who do not receive federal disability benefits, more than 90% already work or are looking for work, or have a disability, go to school, or care for a family member and are unable to work. Most Medicaid enrollees who are employed hold low-wage jobs, often with long or irregular hours and limited benefits, if any. Notably, their jobs often do not provide health insurance. A new Urban Institute study found 2% of Medicaid expansion enrollees without dependents, about 300,000 people, report a lack of interest in working as the reason for not having employment. The nonpartisan Congressional Budget Office estimates the work requirement in the House version of the legislation would lead to about 5 million adults losing Medicaid coverage by 2034; it has not yet analyzed the Senate bill. The Center for Budget and Policy Priorities, a left-leaning research organization, estimates that the Senate's version could cause as many as 380,000 more people to lose coverage. According to the CBO, the work-requirement provision represents the largest cut to Medicaid in the House bill — about $300 billion over a decade, reflecting the savings from no longer covering millions of current enrollees. The projected savings are telling, said Anthony Wright, executive director of Families USA, a consumer policy and advocacy organization. "That gives a sense of the order of its magnitude and harshness," he said. Wright said that Republican-led states are likely to impose more burdensome reporting requirements. But even a less stringent approach, he said, will impose paperwork mandates that cause eligible beneficiaries to lose coverage. Stephanie Carlton, chief of staff for the Centers for Medicare & Medicaid Services, said June 24 at the Aspen Ideas Festival in Colorado that Trump administration officials believe the CBO is overstating the impact of the work requirement. "We're making it easy" for people to report their work hours using technology, she said. She defended the proposed requirement as a way of better integrating Medicaid beneficiaries into their communities. "We're a society, especially through covid, that disengaged from communities. We spend a lot of time online, on social media, and we lose that human-to-human interaction," Carlton said. "We're asking folks to engage in their communities. That's a fundamentally good thing to do that's part of getting benefits." Under the GOP proposal, people would have to meet the new work requirements when they initially sign up for Medicaid, then report their work or exemption status at least every six months — and potentially as frequently as every month. "This is not a conversation America should be in," said Leslie Dach, founder and chair of Protect Our Care, an advocacy group that supports the Affordable Care Act. "Think of real life. People are seasonal workers, or they work in retail, and it goes out of business or hours change. If you miss one month, you're kicked off." The GOP legislation lists disability as an exemption, along with circumstances such as being incarcerated or being the parent of a dependent child. (The Senate bill, released on June 16, would exempt only the parents of children 14 and under.) But even existing state and federal programs serving those with disabilities have different standards for determining eligibility. Kevin Corinth, a senior fellow at the conservative American Enterprise Institute, said states may face challenges because many Medicaid enrollees with disabilities do not get Social Security Disability Insurance. The federal government provides what's called Supplemental Security Income to those who meet certain thresholds for being low-income and disabled, and states are required to enroll SSI recipients in Medicaid. But about two-thirds of adult enrollees who are under age 65 and disabled — that is, have difficulties with vision, hearing, mobility, or cognitive function, or in other areas — do not receive SSI, according to KFF. "It's hard to know where to draw the line on who is disabled enough" to be exempt from the work requirement, Corinth said. "Some people will fall through the cracks, and states will have to do the best job they can." He said states will be expected to rely on government databases, such as those maintained by their labor departments, to determine whether enrollees are working. But proving a disability could be more taxing for enrollees themselves, he said. Two states that previously tried enacting Medicaid work requirements created strict rules for people with disabilities to get an exemption. In Arkansas, the Medicaid work requirement had a 10-step online exemption process for individuals who were not automatically exempted by the state. Consequently, although 30% of people subject to the requirement reported one or more serious health limitations, only 11% obtained a long-term exemption, according to the National Health Law Program. Medicaid enrollees in Arkansas described a poorly functioning web-based reporting portal, inadequate outreach, and widespread confusion, according to focus-group interviews conducted by KFF. Georgia's Medicaid work requirement also has presented challenges for people seeking an exemption based on a disability. They must request a "modification" from the state on its online portal, then wait for a phone call from the state to set up an interview to review the application. Then they must enroll in the state's job-training program before being allowed to sign up for Medicaid, according to the National Health Law Program. Georgia has not disclosed how many people have applied for an exemption because of a disability or how many were approved. Over 1 in 5 Medicaid enrollees have a disability, including 22% of those ages 19 to 49 and 43% of those 50 to 64, according to KFF. Michael Karpman, principal research associate for the Urban Institute, said his group's findings — that only a small fraction of Medicaid enrollees are unemployed because they aren't interested in a job — explain why work-requirement programs in Arkansas and Georgia had no significant effect on employment even as they increased the number of uninsured adults. "Many people fall off the Medicaid rolls due to red-tape reasons," he said, noting challenges requesting exemptions or reporting work. "People struggle with the documentation process." Karpman said many people rely on Medicaid when they lose jobs that provide health coverage. The GOP work requirement, though, would deny them coverage while they're seeking new jobs. Chris Bryant, a Medicaid enrollee in Lexington, Kentucky, has a bleeding disorder and lives in government housing on $1,100 per month in federal disability payments. He said adding a work requirement to Medicaid will only add barriers for people whose health issues prevent them from working. "It will be messy," he said. Bryant, 39, said he knows people on Medicaid who could work but don't, though he surmises it's a small portion of the population. "People are on Medicaid because they have to have it and have no other option." Emmarie Huetteman contributed to this report. KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism.
New York Times
17-06-2025
- Business
- New York Times
Trump Administration Live Updates: Senate Republicans Propose Deeper Medicaid Cuts
The 549-page measure, released by the Senate Finance Committee, outlines changes to Medicaid that would be far more aggressive than the version passed in the House, making millions more Americans subject to a work requirement. Senate Republicans on Monday released legislation that would cut Medicaid far more aggressively than would the House-passed bill to deliver President Trump's domestic agenda, while also salvaging or slowing the elimination of some clean-energy tax credits, setting up a fight over their party's marquee policy package. The measure, released by the Senate Finance Committee, contains the core provisions of that chamber's version of the legislation that Republicans muscled through the House last month and are hoping to speed through the Senate and deliver to Mr. Trump's desk by July 4. But its differences with that bill are substantial and are all but certain to complicate the measure's path to enactment, casting doubt on that timetable. Most notably, the proposal would take a slower and less sweeping approach to phasing out clean-energy tax credits created during the Biden administration, and cover part of the cost of doing so by imposing deeper and more expansive cuts to Medicaid. While the House measure would add a new work requirement to Medicaid for childless adults, the Senate proposal would expand its application to the parents of older children. It also would crack down even harder than the House bill on strategies that many states have developed to tax medical providers and pay them higher prices for Medicaid services. In making the case for the bill, Republicans focused on another, far more politically popular element of the measure: its extension of tax cuts that were enacted in 2017 and are set to expire at the end of the year. Image A $7,500 tax credit for buyers of electric cars would phase out immediately within 180 days of the bill passing into law. Credit... Lauren Justice for The New York Times 'This bill prevents an over-$4 trillion tax hike and makes the successful 2017 Trump tax cuts permanent, enabling families and businesses to save and plan for the future,' Senator Mike Crapo of Idaho, the chairman of the Finance Committee, said in a statement. 'I look forward to continued coordination with our colleagues in the House and the administration to deliver President Trump's bold economic agenda for the American people as quickly as possible. But the changes in the Senate bill could make final passage in the House more difficult. After pushing the bill through the House by a single vote, Speaker Mike Johnson had implored senators repeatedly not to make major changes, reminding them that he is working with narrow margins. At least two factions of House Republicans on Monday said they were disappointed with the Senate provisions. Senators have yet to decide how to handle the limit on the state and local tax deduction, angering House lawmakers from high-tax states who are lobbying to raise the cap, and who have demanded that senators accept the higher one they negotiated. The House-passed bill would quadruple the current $10,000 limit. The cap would shrink for people making more than $500,000. The proposal also drew the ire of conservatives in the House who want to entirely phase out the clean-energy tax credits created by President Joseph R. Biden Jr.'s climate law. 'That's not close to enough,' Representative Chip Roy of Texas wrote on social media, describing the measure's attempt to balance additional Medicaid cuts against salvaging some tax credits into the next decade. The climate law 'needs to be terminated as President Trump said.' But much of the focus is likely to center on the Senate's Medicaid work requirement. The changes add to a House bill that already made around $1 trillion in cuts to spending on federal health programs, including Medicaid and marketplaces established under Obamacare, which together the Congressional Budget Office has estimated would cause around 11 million more Americans to be uninsured in 2034. 'The Republican Senate Finance draft cuts to Medicaid are deeper and more devastating than even the Republican House's disaster of a bill,' Senator Chuck Schumer, Democrat of New York and the minority leader, said in a statement. Unlike the House version, the Senate bill would require adults with children over age 14 to work or volunteer at least 80 hours a month to qualify for the health insurance program. The work requirement in the House bill was already the strictest Republicans have ever proposed — estimated to cause around 5.2 million Americans to lose Medicaid coverage by the end of the decade. Adding parents to the program would likely mean a larger number of people would lose coverage. The bill also would lower federal funding to many states that have expanded their Medicaid programs through a complicated formula adjustment. The change would limit how much states are allowed to tax certain health care providers from a cap of 6 percent to a new top rate of 3.5 percent, with the change phasing in over several years. The taxes, which are used in every state but Alaska, have allowed states to increase federal funding for their programs. They have been decried by critics as a form of 'money laundering,' but the reduction would mean significant holes in state Medicaid budgets, and could result in lower payments to hospitals or other cuts to state budgets. Like the House measure, the Senate bill would quickly end many federal tax credits for clean energy, but it phases out a few others more slowly. Some Republican senators, including Lisa Murkowski of Alaska, Thom Tillis of North Carolina, and John Curtis of Utah, had expressed concerns that the House bill would withdraw support from energy companies too abruptly. A lucrative tax credit for businesses that build wind and solar farms would begin rapidly winding down. Companies could qualify for the full tax break if they begin construction this year, 60 percent of the tax break if they begin in 2026 and 20 percent of the tax credit if they begin in 2027. After that, the credit would disappear. That's a slightly longer runway for renewable energy than allowed by the House bill, which would have ended these tax breaks almost immediately. But it is a much quicker phaseout than many clean-energy proponents had pushed for. In another notable change, the Senate bill would preserve existing tax credits for companies that build nuclear reactors, geothermal plants, hydropower dams or battery storage through 2033. Energy Secretary Chris Wright and some companies had urged Congress to keep credits for so-called base load electricity sources that can operate at all hours, unlike wind and solar power. Other tax breaks would end almost immediately: A $7,500 tax credit for buyers of electric cars would phase out within 180 days of the bill's enactment. Tax credits for homeowners who install solar panels on their rooftops or install heat pumps would also end within that time frame. A subsidy for making hydrogen fuels would expire this year. The Senate measure, like the House version, also adds new restrictions on tax breaks for both power plants and factories that build solar panels, batteries or other low-carbon technologies by disqualifying companies that use certain components from China. Many companies had complained that the House language on 'foreign entities of concern' was far too restrictive, since China dominates global supply chains. While the Senate version makes numerous adjustments, industry groups said they were still reviewing the new language. The measure looks to deliver on the president's promises to eliminate taxes on tips and overtime pay, but would make some key tweaks. The amount that individuals could claim is capped under each, and the benefits are phased out starting at new income levels. The House version of the legislation sought to make good on Mr. Trump's campaign promise to eliminate taxes on Social Security benefits by instead creating a bonus $4,000 deduction available to Americans 65 and older, with the benefit shrinking at higher income levels. The Senate bill would grant them a $6,000 tax deduction. The child tax credit is also handled differently. Senate Republicans proposed to permanently increase the credit to $2,200 per child beginning in the 2025 tax year. House Republicans had proposed to bump up the credit to $2,500, but only through 2028. It also would grant some of businesses's most sought-after tax deductions, including for research and development, on a permanent basis, unlike the House bill. The provisions proposed by the Senate would increase the debt limit by $5 trillion; the House-passed bill called for lifting it by $4 trillion, a move that was expected to allow the nation to continue borrowing money through the 2026 midterm elections.
CBS News
15-06-2025
- Health
- CBS News
Medicaid enrollees fear losing health coverage if Congress enacts work requirements
It took Crystal Strickland years to qualify for Medicaid, which she needs for a heart condition. Strickland, who's unable to work due to her condition, chafed when she learned that the U.S. House had passed a bill that would impose a work requirement for many able-bodied people to get health insurance coverage through the low-cost, government-run plan for lower-income people. "What sense does that make?" she asked. "What about the people who can't work but can't afford a doctor?" The measure is part of the version of President Donald Trump's "Big Beautiful" bill that cleared the House last month and is now up for consideration in the Senate. Trump is seeking to have it passed by July 4. The bill, as it stands, would cut taxes and government spending — and also upend portions of the nation's social safety net. For proponents, the ideas behind the work requirement are simple: Crack down on fraud and stand on the principle that taxpayer-provided health coverage isn't for those who can work but aren't. The measure includes exceptions for those who are under 19 or over 64, those with disabilities, pregnant women, main caregivers for young children, people recently released from prisons or jails, or during certain emergencies. It would apply only to adults who receive Medicaid through expansions that 40 states chose to undertake as part of the 2010 health insurance overhaul. Many details of how the changes would work would be developed later, leaving several unknowns and causing anxiety among recipients who worry that their illnesses might not be enough to exempt them. Advocates and sick and disabled enrollees worry, based largely on their experience, that even those who might be exempted from work requirements under the law could still lose benefits because of increased or hard-to-meet paperwork mandates. Strickland, a 44-year-old former server, cook, and construction worker who lives in Fairmont, North Carolina, said she could not afford to go to a doctor for years because she wasn't able to work. She finally received a letter this month saying she would receive Medicaid coverage, she said. "It's already kind of tough to get on Medicaid," said Strickland, who has lived in a tent and times and subsisted on nonperishable food thrown out by stores. "If they make it harder to get on, they're not going to be helping." Steve Furman is concerned that his 43-year-old son, who has autism, could lose coverage. The bill the House adopted would require Medicaid enrollees to show that they work, volunteer or go to school at least 80 hours a month to continue to qualify. A disability exception would likely apply to Furman's son, who previously worked in an eyeglasses plant in Illinois for 15 years despite behavioral issues that may have gotten him fired elsewhere. Furman said government bureaucracies are already impossible for his son to navigate, even with help. It took him a year to help get his son onto Arizona's Medicaid system when they moved to Scottsdale in 2022, and it took time to set up food benefits. But he and his wife, who are retired, say they don't have the means to support his son fully. "Should I expect the government to take care of him?" he asked. "I don't know, but I do expect them to have humanity." About 71 million adults are enrolled in Medicaid now. And most of them — around 92% — are working, caregiving, attending school or disabled. Earlier estimates of the budget bill from the Congressional Budget Office found that about 5 million people stand to lose coverage. A KFF tracking poll conducted in May found that the enrollees come from across the political spectrum. About one-fourth are Republicans; roughly one-third are Democrats. The poll found that about 7 in 10 adults are worried that federal spending reductions on Medicaid will lead to more uninsured people and would strain health care providers in their area. About half said they were worried reductions would hurt their ability or their family to get and pay for health care. Amaya Diana, an analyst at KFF, points to work requirements launched in Arkansas and Georgia as keeping people off Medicaid without increasing employment. Amber Bellazaire, a policy analyst at the Michigan League for Public Policy, said the process to verify that Medicaid enrollees meet the work requirements could be a key reason people would be denied or lose eligibility. "Massive coverage losses just due to an administrative burden rather than ineligibility is a significant concern," she said. One KFF poll respondent, Virginia Bell, a retiree in Starkville, Mississippi, said she's seen sick family members struggle to get onto Medicaid, including one who died recently without coverage. She said she doesn't mind a work requirement for those who are able, but worries about how that would be sorted out. "It's kind of hard to determine who needs it and who doesn't need it," she said. Lexy Mealing, 54 of Westbury, New York, who was first diagnosed with breast cancer in 2021 and underwent a double mastectomy and reconstruction surgeries, said she fears she may lose the medical benefits she has come to rely on, though people with "serious or complex" medical conditions could be granted exceptions. She now works about 15 hours a week in "gig" jobs but isn't sure she can work more as she deals with the physical and mental toll of the cancer. Mealing, who used to work as a medical receptionist in a pediatric neurosurgeon's office before her diagnosis and now volunteers for the American Cancer Society, went on Medicaid after going on short-term disability. "I can't even imagine going through treatments right now and surgeries and the uncertainty of just not being able to work and not having health insurance," she said. Felix White, who has Type I diabetes, first qualified for Medicaid after losing his job as a computer programmer several years ago. The Oreland, Pennsylvania, man has been looking for a job, but finds that at 61, it's hard to land one. Medicaid, meanwhile, pays for a continuous glucose monitor and insulin and funded foot surgeries last year, including one that kept him in the hospital for 12 days. "There's no way I could have afforded that," he said. "I would have lost my foot and probably died." ___ Associated Press writer Susan Haigh in Hartford, Connecticut, contributed to this article.
Washington Post
15-06-2025
- Health
- Washington Post
Medicaid enrollees fear losing health coverage if Congress enacts work requirements
It took Crystal Strickland years to qualify for Medicaid, which she needs for a heart condition. Strickland, who's unable to work due to her condition, chafed when she learned that the U.S. House has passed a bill that would impose a work requirement for many able-bodied people to get health insurance coverage through the low-cost, government-run plan for lower-income people.
