\t\t<\/p>\n Este art\u00edculo estar\u00e1 disponible en espa\u00f1ol en El Tiempo Latino<\/a>.<\/em><\/p>\n Republicans say that able-bodied adults who don\u2019t work would lose Medicaid coverage under the House tax-cuts-and-spending bill, while Democrats say the legislation would hurt vulnerable groups. The bill\u2019s main target is those able-bodied adults, but other groups would lose coverage due to paperwork burdens and other provisions in the bill, health policy experts say.<\/p>\n The majority of coverage losses under the bill would come from those who became eligible for Medicaid due to an expansion of the program under the Affordable Care Act \u2014 those enrollees would face new work requirements unless they were subject to an exemption.<\/p>\n \u201cThe challenge here is that these work requirements also become sort of a paperwork requirement,\u201d Jennifer Tolbert<\/a>, deputy director of the Program on Medicaid and the Uninsured at the health policy research group KFF, told us in an interview. In order to keep their Medicaid coverage, people have to document that they\u2019re working the required number of hours or meet the criteria for an exemption. It\u2019s not yet known what kind of documents will be required, she said, but it\u2019s \u201cquite likely that there will be people \u2026 who have reported disabilities, who have other chronic conditions, and \u2026 who are caring for children or elderly parents, who may also lose coverage\u201d because they aren\u2019t able to provide the correct documents.<\/p>\n Overall, the nonpartisan Congressional Budget Office estimated<\/a> that the bill would lead to 10.9 million more people being uninsured in 2034, with 7.8 million of those due to the bill\u2019s Medicaid provisions and the rest due to changes concerning the Affordable Care Act\u2019s insurance marketplaces. The House narrowly passed<\/a> the bill on May 22, and the Senate is now considering it.<\/p>\n House Speaker Mike Johnson and other Republican lawmakers have said that those losing insurance coverage would be people who shouldn\u2019t have received it in the first place.<\/p>\n \u201cThe numbers of Americans who are affected are those that are entwined in our work to eliminate fraud, waste and abuse,\u201d Johnson said<\/a> on CNN\u2019s \u201cState of the Union\u201d on May 25. He claimed that \u201cpregnant women and young single mothers, the disabled, the elderly \u2026 are protected\u201d under the bill.<\/p>\n The House speaker and other Republicans have said the bill, called the One Big Beautiful Bill Act<\/a>, actually saves the Medicaid program, even though it cuts federal Medicaid spending. In a May 20 statement, Rep. Tom Cole of Oklahoma said<\/a> the bill \u201cstops the subsidization of competent adults who are just choosing to not work.\u201d<\/p>\n KFF estimated<\/a> that the bill would reduce federal Medicaid spending by a net $793 billion over 10 years, based on CBO\u2019s analysis<\/a>. That\u2019s a 12% reduction in federal Medicaid funding. Yet, Johnson has claimed that the spending cuts aren\u2019t cuts at all. \u201cThere are no Medicaid cuts in the Big Beautiful Bill. We\u2019re not cutting Medicaid,\u201d he said<\/a> on NBC\u2019s \u201cMeet the Press\u201d on June 1. \u201cWhat we\u2019re doing is strengthening the program. We\u2019re reducing fraud, waste and abuse that is rampant in Medicaid to ensure that that program is essential for so many people, ensure that it\u2019s available for the most vulnerable.\u201d<\/p>\n (Johnson has also cited \u201cmore than 1.4 million illegal aliens on Medicaid.\u201d We\u2019ve already written<\/a> about that false claim. The CBO said those individuals would lose coverage from \u201cstate-only funded programs,\u201d not from Medicaid. The bill would reduce federal Medicaid funding to states that continue their own health insurance programs for immigrants in the U.S. illegally.)<\/p>\n Democrats, meanwhile, have focused on potential impacts on \u201cvulnerable\u201d groups.<\/p>\n Democratic Sen. Michael Bennet of Colorado said<\/a> on CNN on May 25 that Johnson\u2019s comments about \u201cable-bodied adults\u201d and \u201cillegal aliens\u201d were \u201cnot true.\u201d Bennet said the House bill would drive \u201ca lot\u201d of health care providers \u201cout of business,\u201d and suggested that kids and families in poverty would be affected by the Medicaid provisions.<\/p>\n The bill has financial implications for some providers, such as community health centers and hospitals, but it\u2019s unclear to what extent they would close as a result. Tolbert said \u201cit will be hard to say\u201d if closures are directly related to the bill. <\/p>\n In a May 27 press conference, Sen. Elizabeth Warren said<\/a> that \u201cevery one\u201d of the approximately 2 million people on Massachusetts\u2019 Medicaid program \u201cwill be at risk of losing their health coverage\u201d under the Republican bill.<\/p>\n Leonardo Cuello<\/a>, a research professor at the Georgetown University McCourt School of Public Policy\u2019s Center for Children and Families, told us: \u201cBasically every type of Medicaid enrollee could be at risk of coverage loss.\u201d\u00a0<\/p>\n But, of course, the vast majority of Medicaid enrollees wouldn\u2019t be expected to lose coverage, even if many are \u201cat risk,\u201d as Warren put it. The health insurance program for low-income individuals covers about 83 million people<\/a> and is jointly funded by the federal government and the states. Coverage losses would vary by state \u2013 and there\u2019s uncertainty about how states would react to the bill\u2019s changes. But KFF estimated<\/a> that Massachusetts\u2019 enrollment would drop by 11% in 2034 under the bill.\u00a0<\/p>\n Nationwide, Medicaid projected enrollment would decline by 12% in 2034, KFF said.\u00a0<\/p>\n We\u2019ll go through what the bill would do and how it could affect Medicaid enrollees.<\/p>\n A large portion of the Medicaid savings in the bill come from new work requirements, or what the legislation calls \u201ccommunity engagement,\u201d for adults who gained coverage under a Medicaid expansion in the Affordable Care Act. This aspect of the bill saves<\/a> an estimated $344 billion over 10 years.<\/p>\n Forty states<\/a> plus Washington, D.C., have implemented that Medicaid expansion. It broadened eligibility to adults under age 65 who earn up to 138% of the federal poverty level, and the federal government provides 90% of the funding for that population. The income eligibility threshold before that varied by state.\u00a0<\/p>\n The expansion population was estimated at 21.3 million people in 2024, according to KFF<\/a>.<\/p>\n The House bill would require those in the expansion group ages 19 to 64 to work, or participate in community service or job training, for a minimum of 80 hours per month. Attending an educational program at least half-time would also qualify, as would earning income equivalent to 80 hours\u2019 worth of minimum-wage work.\u00a0<\/p>\n States would be required to exempt certain groups, including pregnant people, parents and caretakers of dependent children and disabled family members, people with substance use disorders and some medical conditions, some people with disabilities, and those who had been in foster care as children, according to a breakdown of the bill<\/a> by Georgetown University\u2019s Center for Children and Families.\u00a0\u00a0<\/p>\n States would need to confirm that requirements were met for at least one month before someone applied for Medicaid or renewed their eligibility, and those renewals must happen at least twice a year. The work requirements would have to be instituted no later than Dec. 31, 2026.\u00a0<\/p>\n The CBO estimated<\/a> that Medicaid coverage would drop by 5.2 million people in 2034 because of the work requirement provision, with 4.8 million being uninsured. Its June 4 letter on these figures said that 18.5 million would be subject to the requirement, though \u201csome\u201d would be exempt. <\/p>\n It\u2019s unclear how many are \u201cable-bodied\u201d and choosing not to work.<\/p>\n Studies have found a small percentage of Medicaid enrollees would fit that description. In an analysis of 2024 Census Bureau survey data, KFF determined<\/a> that 8% of Medicaid recipients under age 65 and not also getting Social Security disability benefits weren\u2019t working because they were retired, unable to find work or another reason. The Center on Budget and Policy Priorities found<\/a> that half of that group was retired.<\/p>\n Nearly two-thirds \u2013 64% \u2013 were working full-time or part-time, and the rest weren\u2019t working due to a disability or illness, caregiving responsibilities, or being a student.\u00a0\u00a0<\/p>\n Johnson has referred to<\/a> \u201cabout 4.8 million able-bodied workers, young men, for example, who are on Medicaid and not working. They are choosing not to work when they can,\u201d calling this \u201cfraud.\u201d But the 4.8 million figure is the CBO estimate of the number who would become uninsured due to the work requirements. The House Energy and Commerce Committee, in a post<\/a> on X, said these were all \u201cable bodied adults choosing not to work.\u201d\u00a0<\/p>\n It\u2019s unknown how many of those individuals fit Johnson\u2019s description. We contacted the House speaker\u2019s office about this figure and his other claims, but we haven\u2019t received a response.\u00a0<\/p>\n Tolbert told us she didn\u2019t know if a CBO breakdown would be able to provide details of what types of Medicaid enrollees will lose coverage under the work requirements, such as single adults, parents or those with disabilities.\u00a0<\/p>\n \u201cIt is patently false that the impact is only going to be on able-bodied individuals,\u201d Cuello said, adding that many people with disabilities aren\u2019t enrolled with an official disability determination and instead are in the expansion population.\u00a0<\/p>\n Michael Karpman<\/a>, a principal research associate in the health policy division at the Urban Institute, told us that if there\u2019s a group of enrollees in the expansion population that should be working but choose not to \u201cit\u2019s small.\u201d The think tank has found that at least 90% of the adults in the expansion population \u201care working \u2026 are in fair or poor health or have a disability, likely have some caregiving responsibilities, or are looking for work. And so most people, the vast majority of people, are participating in the activities prescribed by the policy, or could potentially meet the exemption criteria from the work requirement.\u201d\u00a0<\/p>\n But \u201cin practice,\u201d he said, \u201ca lot of people who are likely to qualify for an exemption are not going to actually get that exemption\u201d because they\u2019ll have trouble with the reporting requirements. \u201cThat\u2019s what we saw in states that previously implemented work requirements. Some people were automatically exempted by the state; most of those who weren\u2019t had difficulty with the reporting bureaucracy in terms of showing that they were exempt or meeting the work requirement.\u201d<\/p>\n Two states have tried such requirements.\u00a0<\/p>\n In Arkansas, which implemented work requirements for Medicaid in 2018, more than 18,000<\/a> adults were disenrolled that year. A federal court ruling stopped<\/a> the program in 2019, after a group of Medicaid enrollees in the state sued. The case provided anecdotal evidence of the problems people had with the reporting requirements. One man in his 40s, who worked at a poultry business, successfully filed documentation at first but then lost coverage when he was unaware that he needed to keep doing so monthly.\u00a0<\/p>\n An Urban Institute study found<\/a> that the work requirement was associated with an increase in the uninsured among the target group for the policy, 30- to 49-year-olds with low incomes. But researchers didn\u2019t find changes in employment.<\/p>\n And in Georgia, which, like the House bill, requires proof of work before enrolling applicants, \u201cvery few people who are eligible for the program have been able to enroll,\u201d Karpman said.\u00a0<\/p>\n As of April 30, the state had enrolled<\/a> about 7,400 low-income adults since the program launched in July 2023, but the state had expected to enroll 47,000 in the first two years.<\/a> The Georgia Budget & Policy Institute has said<\/a> 240,000 people in the state are \u201cpotentially eligible.\u201d<\/p>\n Jennifer Haley<\/a>, also a principal research associate at the Urban Institute, told us that states won\u2019t have perfect information on enrollees\u2019 health conditions that would be subject to an exemption. There\u2019s not \u201da database of whether someone\u2019s, quote, able bodied or not.\u201d<\/p>\n Workers who are self-employed or gig workers also might have a hard time producing documents showing hours worked, these experts said.\u00a0\u00a0<\/p>\n Karpman and Haley were co-authors on a March report from the Urban Institute that analyzed a more limited 2023 congressional proposal for work requirements. \u201cOur findings suggest states will disenroll significantly more expansion adults who should be exempt or are already engaged in work activities relative to the disenrollment of adults who are not engaged in work activities and do not meet the exemption criteria,\u201d the report said<\/a>. <\/p>\n Under the current bill, the expansion population has to renew eligibility at least twice a year, instead of once a year, which could lead to more people losing coverage because they miss notices or don\u2019t file the correct paperwork \u2014 or what\u2019s known as procedural disenrollment<\/a> \u2014 not because they aren\u2019t eligible.\u00a0<\/p>\n This can have a ripple effect, where some children who are eligible could lose coverage when their parents are dropped from Medicaid for failing to complete the renewal process. If parents enroll, they are more likely to get their kids enrolled, and the reverse impact also occurs. \u201cWe know that when parents lose coverage, often their children still lose coverage as well,\u201d Tolbert said. <\/p>\n The CBO estimated<\/a> an increase in the uninsured of 700,000 people in 2034 due to the eligibility redeterminations.<\/p>\n There are a lot of unknowns with how the work requirements could play out, Tolbert said. States have the option to require more frequent eligibility renewals or proof of more than one prior month of work. \u201cState choices here could have significant implications in terms of who is able to meet the requirements or not,\u201d she said. While the work requirements are expected to have the largest impact on enrollment, there are other provisions<\/a> that could lead to lost or reduced coverage. <\/p>\n The bill delays the implementation of some Biden-era rules until 2035. One of those made it easier for seniors or people with disabilities with Medicare coverage who are also eligible for Medicaid to enroll in the latter. In these cases, Medicaid pays for supplemental benefits and Medicare cost-sharing. A preliminary CBO report estimated<\/a> that 1.3 million in 2034 would lose their Medicaid coverage due to this provision but retain Medicare. <\/p>\n That Biden-era rule also streamlined enrollment and renewals for children and eliminated waiting periods for kids to enroll in the Children\u2019s Health Insurance Program. \u201cThe eligibility enrollment rule would fix those problems, and they are repealing that rule,\u201d Cuello said. \u201cSo again, that is absolutely going to impact the eligibility of children. Less children will have coverage under the Children\u2019s Health Insurance Program because of those policies.\u201d<\/p>\n The CBO estimated that this provision would increase the number of uninsured by 600,000 in 2034.<\/p>\n Cuello\u2019s center also wrote that the bill prohibits<\/a> Medicaid payments from going to Planned Parenthood clinics for 10 years, limiting at least some people\u2019s access to care.<\/p>\n And there are the 1.4 million immigrants in the country illegally who CBO estimated would lose coverage through state-only programs. These aren\u2019t Medicaid or CHIP enrollees, but the bill uses Medicaid to pressure states to drop those programs. As we\u2019ve explained<\/a>, the bill proposes reducing the federal Medicaid match for states\u2019 ACA expansion populations from 90% to 80% if they provide health coverage to people living in the country illegally, regardless of how that program is funded.<\/p>\n According to KFF<\/a>, there are 14 states, plus Washington, D.C., that have such programs to cover children regardless of immigration status, including seven states and D.C. that also cover some adults.<\/p>\n In addition, the bill increases cost-sharing for expansion enrollees with income above the federal poverty level, adding a $35 co-pay for services, but exempting primary care, and services for mental health or substance use disorders. <\/p>\n Democrats have said that the bill would force health care providers, such as nursing homes, community health centers or rural hospitals, to close. On CNN, Bennet said the legislation would drive \u201ca lot\u201d of health care providers \u201cout of business,\u201d while Warren, in her press conference, said that \u201chospitals and community health centers\u201d would be \u201cforced to close.\u201d The bill could hurt the finances of these providers, but how many would close their doors as a result is unknown. <\/p>\n Tolbert told us that \u201cit will be hard to say that any hospital closures or other providers going out of business \u2026 is directly related to these Medicaid changes.\u201d But there will be financial implications, she said.<\/p>\n Community health centers, for example, are required to provide care regardless of someone\u2019s ability to pay, she said. So centers that see a decrease in their patients\u2019 Medicaid coverage would face increased financial pressure.<\/p>\n Rural hospitals also could be at risk. The bill would prohibit states from increasing or instituting new provider taxes, which states have used to supplement payments to hospitals to cover uncompensated care, Tolbert explained.<\/p>\n Cuello said that some rural hospitals will go bankrupt because of the bill\u2019s provisions. \u201cI can say with a good degree of comfort that if you have, at current level of funding, a lot of hospitals at risk of closure, and you massively decrease funding \u2026 we can safely assume that there will be some greater number of hospitals that closes.\u201d<\/p>\n Cuello pointed us to a June report from the Center for Healthcare Quality & Payment Reform that said<\/a> about a third of rural hospitals in the U.S. \u201care at risk of closing because of the serious financial problems they are experiencing,\u201d and 14%, or 314 rural hospitals, are \u201cat immediate risk of closing.\u201d<\/p>\n Similarly, Bennet\u2019s and Warren\u2019s offices pointed to the financial frailty of rural hospitals and health centers and how a reduction in Medicaid payments and increased uncompensated care costs would hurt them. <\/p>\n For instance, Warren\u2019s office cited a report from the Urban Institute that estimated<\/a> that spending for health care services would decline by $771 billion over 10 years due to the bill and uncompensated care costs for the uninsured would go up $198 billion.<\/p>\n The senator\u2019s office also cited comments by Shade Cronan with the Massachusetts League of Community Health Centers, who said the average community health center gets about a third of its revenue from Medicaid. Cronan told<\/a> New England Public Media in April that the state probably wouldn\u2019t be able to cover a cut in that revenue stream. \u201cAnd then health centers will have to make really difficult decisions, potentially to reduce services, to close sites, to lay off staff.\u201d<\/p>\n About 19% of hospital care spending in 2023 came from Medicaid, KFF reported<\/a>, and half of rural hospitals in non-ACA-expansion states and 41% in expansion states had negative margins<\/a> that year. <\/p>\n All of that shows that a reduction in Medicaid revenue would have a financial impact. But it\u2019s unclear to what extent health care providers would be forced to close because of it and, as Tolbert said, difficult to determine later.<\/p>\n![\"\"](\"https:\/\/cdn.factcheck.org\/UploadedFiles\/Medicaid-Magnify-400-x-267.png\")
The Bill\u2019s Work Requirements<\/h2>\n
Impact of Work Requirements<\/h2>\n
<\/strong>And federal guidance will come later on specific medical conditions that qualify for an exemption or what documents states will accept. <\/p>\nOther Provisions<\/h2>\n
Impact on Health Care Providers<\/h2>\n
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