Too sick to get sick, some Americans are worried that Trump’s bill will strip them of their health insurance

Stephanie Ivory considers Medicaid to have gastrointestinal conditions and treatment for a bulging disc that is standing or sitting for a long period of time. Her obstacles will prevent her from working, she said.

Ivory, 58, of Columbus, Ohio, believes he will be exempt from the requirement for adult Medicaid recipients to work, but he is worried about the reporting process. “It’s hard enough to just renew Medicaid coverage every six months with phone and paperwork,” she said.

In Warrenton, Missouri, Dennis Somer hasn’t worked for five years and relies on Medicaid to care for back and knee anxiety, high blood pressure and severe arthritis.

The 58-year-old Sommer assumes that he can easily qualify for the exemption in a doctor’s note. “There’s too much abuse in the system,” she said. She added that she is not worried that others have lost their reporting because they have not met the reporting requirements.

“It’s their own fault because they should update their address in the state and read their email,” she said.

President Donald Trump’s one big beautiful bill law, the vast law to extend his tax cuts and enact many of his domestic agenda, requires 40 states and the District of Columbia. Registrants must regularly submit documents certifying that they are eligible for at least 80 hours a month, or exemptions, and certifying that they attend school for at least 80 hours.

Many Republicans say that adults without disabilities should not be in Medicaid, and argue that work requirements encourage more people to get jobs. House Speaker Mike Johnson said it would help preserve Medicaid “for the right and right people.”

Johnson last month claimed that 4.8 million Medicaid subscribers were choosing not to work. A Johnson spokesperson did not respond to requests for comment.

A study by the Urban Institute and KFF shows that among working-age enrollees who do not receive federal disability benefits, over 90% of people are already at work, looking for work, or have a disability, not going to school or caring for a family.

Most Medicaid enrolled in employed people often have low paying jobs when they have long or irregular hours and limited benefits. In particular, their work often does not provide health insurance.

A new Urban Institute survey shows that 2% of Medicaid extended subscribers without dependents, or about 300,000, report a lack of interest in working as a reason for not having employment.

The Nonpartisan Congressional Budget Office estimates that by 2034, roughly 5 million adults will lose Medicaid compensation. We have not yet analyzed the Senate bill. The Center for Budget and Policy Priorities, a left-leaning research organisation, estimates that the Senate version could potentially lose compensation for as many as 380,000 people.

According to the CBO, the labor request provision represents the biggest Medicaid cut in the House bill. This reflects the fact that it has been around $300 billion over a decade, and no longer covers millions of subscribers today.

The expected savings are said Anthony Wright, executive director of Family USA, a consumer policy and advocacy group. “It gives you a sense of the order of its size and harshness,” he said.

Wright said Republican-led states are likely to impose more burdensome reporting requirements. But even a more stringent approach would impose a mandate on documents that would cause eligible beneficiaries to lose coverage, he said.

Stephanie Carlton, chief of staff at the Centers for Medicare and Medicaid Services, said on June 24 that Aspen Idea: Health in Colorado, Trump administration officials believe CBOs are exaggerating the impact of job requirements.

“We make it easier,” she said, for people to use technology to report their working hours. She defended the proposed requirement as a way to integrate Medicaid beneficiaries into the community.

“We are society, especially through Covid, which is freed from our community. We spend a lot of our time online on social media and lose our interactions between humans,” Carlton said. “We ask people to engage in their community. That’s fundamentally good, that’s part of profiting.”

Under the GOP proposal, people must meet new work requirements when they first sign up for Medicaid and report their work or exemption status at least every six months and as often as monthly.

“This is not the conversation America should be around,” said Leslie Dach, founder and chairman of Protect Our Care, an advocacy group that supports affordable care laws. “Think real life. People are seasonal workers or work in retail. And that’s going to be a business out of business or a time change. If you miss a month, you’ll be kicked off.”

The GOP Act lists disability as exemptions and lists situations such as being incarcerated or being a parent of a dependent child. (The Senate bill, released on June 16th, exempts parents of children under the age of 14.)

However, even existing state and federal programs that serve people with disabilities have different criteria for determining eligibility.

Kevin Corinth, a senior fellow at the Conservative American Institute of Business Research, said the state could face challenges as many Medicaid enrollees with disabilities do not have Social Security Disability Insurance.

The federal government provides what is called Supplementary Security Income to those who meet certain thresholds because they are low-income and disabled, and states are required to register Medicaid SSI recipients.

However, according to KFF, about two-thirds of people with disabilities under the age of 65 (i.e. difficult in vision, hearing, mobility, or other areas) do not receive SSI.

“It’s hard to know where to draw who is sufficiently invalidated,” Corinth said. “Some people have to go through the cracks and the state has to do the best job they can.”

He said it is expected that it will rely on government databases such as those maintained by the Ministry of Labor to determine whether the registrants are at work. However, proving disability could potentially tax the registrants themselves more, he said.

Josephine Rios, who works in nursing at Kaiser Permanente, California, was an international union member of the service workers gathered outside the Capitol. She is worried that potential Medicaid reductions could lead to her job losses and cause her grandchildren in Medicaid due to her disability. (Phil Galewitz/KFF Health News)

Two states that previously sought to enact Medicaid work requirements have created strict rules to allow people with disabilities to get exemptions.

In Arkansas, Medicaid labor requirements had a 10-step online exemption process for individuals who were not automatically exempted by the state.

As a result, 30% of those covered by the requirement reported one or more serious health restrictions, while only 11% received a long-term exemption, according to the National Health Act program.

According to a focus group interview conducted by KFF, Medicaid subscribers in Arkansas described inadequately functional web-based reporting portals, inadequate outreach and widespread confusion.

Georgia’s Medicaid work requirements presented challenges to those seeking disability-based exemptions. They will require a “change” from the state on the online portal and they will have to set up an interview to wait for a call from the state to check the application. According to the National Health Act program, you must register with the state’s employment training program before you are allowed to sign up for Medicaid.

Georgia has not disclosed how many people have applied for exemptions due to disability or how many people have been approved.

According to KFF, more than one in five Medicaid enrollees have disabilities.

Michael Karpman, a lead investigator at the Urban Institute, said his group’s findings — only a small portion of Medicaid enrolled are unemployed because they are not interested in the job, but explains why Arkansas and Georgia labor programs increased the number of uninsured adults, but did not significantly affect employment.

“A lot of people fall from the Medicaid roll for the reasons of red tape,” he said. We focused on issues requiring exemptions or reporting work. “People are struggling with the documentation process.”

Karpman said many people rely on Medicaid when they lose jobs that provide health insurance. However, the requirements for GOP work reject coverage while seeking new work.

Chris Bryant, a Medicaid registrant in Lexington, Kentucky, has a bleeding disorder and lives in a government housing complex for $1,100 a month on federal disability payments. He said adding work requirements to Medicaid would only add a barrier to those whose health issues prevent them from working. “It’s going to be messy,” he said.

Bryant, 39, said he knows Medicaid people who can but don’t, but he estimates that it is a small part of the population. “People use Medicaid because they need to have it and have no other options.”

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KFF Health News is a national newsroom that produces detailed journalism on health issues. Along with policy analysis and voting, KFF Health News is one of KFF’s three major operating programs. KFF is a donated non-profit organization that provides the country with information on health issues.