• Up to 5.2 million Americans at risk of losing coverage under proposed rules
• Republicans aim to enforce 80-hour monthly work or training for Medicaid recipients
• Critics warn the move will harm low-income adults and increase administrative costs
A sweeping tax and spending bill released by House Republicans includes a controversial provision that could strip health coverage from millions of low-income Americans by 2026.
The legislation, which is part of the GOP’s budget reconciliation package, proposes implementing mandatory work requirements for certain Medicaid beneficiaries starting in 2029.
The measure doesn't go as far as some had expected. It doesn’t lower the minimum share the federal government contributes to Medicaid in each state, cap per-person federal spending in the program or other steps some spending hawks sought, which may cause conservative Republicans to refuse to back it.
The issue is becoming divisive for Congressional Republicans.
Sen. Josh Hawley (R-Mo.) warned against slashing Medicaid spending. In an op-ed published Monday in The New York Times, Hawley said that paying for President Trump’s domestic agenda by slashing health care for the working poor “is both morally wrong and politically suicidal.”
The proposal requires that individuals aged 19 to 64 complete at least 80 hours per month of work, community service, or job training to retain their Medicaid eligibility.
According to independent estimates from the Robert Wood Johnson Foundation and the Urban Institute, this change could lead to the loss of coverage for between 4.6 and 5.2 million people, even among those who are already working or would be exempt, due to confusion or lack of awareness.
'Putting up barriers'
Democratic lawmakers and healthcare advocates argue the move would be especially harmful to vulnerable populations. “This isn’t about efficiency and cost-cutting,” said Rep. Frank Pallone (D-N.J.), in a Bloomberg News report. “It’s about putting up barriers to care in a program that already operates more cost-effectively than Medicare or private insurance.”
The bill also introduces other Medicaid reforms, including new cost-sharing requirements and delays to Biden-era access initiatives, while pressuring states like California that offer Medicaid to undocumented immigrants. The House Energy and Commerce Committee is expected to mark up the legislation this week.