Researchers: Budget Bill’s Work Requirements Could Cause 8.6 Million to Lose Medicaid Coverage
An analysis by the Washington, D.C.-based Center on Budget and Policy Priorities, a nonpartisan research and policy institute, has found that large numbers of Americans whose health insurance in recent years has been covered by the expansion of Medicaid programs under the Affordable Care Act (ACA) who in theory should not lose coverage under the reconciliation bill for the 2026 federal budget published by the House Energy and Commerce Committee, could actually lose that coverage. That, the analysis published on May 13, found, is because of how the state requirements for eligibility are structured. The result, the Center estimates, would be at least 8.6 million people losing coverage as a result.
The analysis, prepared by Elizabeth Zhang and Gideon Lukens, began thus: “The House Republican reconciliation legislation currently under consideration in the Energy & Commerce Committee would take away health coverage and leave at least 8.6 million people uninsured as it cuts at least $715 billion in health care spending, mostly from Medicaid, according to initial estimates by the Congressional Budget Office.[1] Among other harmful proposals, the bill would take Medicaid coverage away from people, largely those enrolled in the Medicaid expansion group, who can’t document that they meet rigid, red-tape-laden work requirements, putting 9.7 million to 14.4 million people at risk of losing Medicaid coverage in 2034. As proposed, the bill would prevent people subject to the requirements from enrolling in Medicaid unless they already are employed. The work requirement provisions in this bill are more extreme than recent bills such as the Limit, Save, Grow Act of 2023, and compared to experiments that states such as Arkansas tried during the first Trump Administration,” they wrote.
Importantly, Zhang and Lukens wrote, “If states experience coverage loss at rates similar to those observed when Arkansas implemented work requirements in 2018-2019, we estimate that 7 million people among those at risk would lose coverage. But coverage losses could well be higher because of the draconian nature of the proposal, and uncertainty about how states will implement it. If a state chooses to implement the policy stringently, nearly all of those at risk could lose coverage.”
Later in their analysis, the researchers wrote that “[E]vidence shows that much of the coverage loss due to work requirements would occur among people who work or should qualify for an exemption but nevertheless would lose coverage due to red tape (states should be able to exempt most people with children automatically, but many others who should be exempt, such as people with disabilities, would not be automatically exempted).[5] If coverage loss is on par with Arkansas’ work requirement experience in 2018-2019, we estimate that 39 percent of expansion enrollees would lose coverage, even though only 13 percent of expansion enrollees either did not work in the past year nor would potentially qualify for an exemption. (See Table 1 for state-level estimates.) In other words, at least 2 in 3 enrollees losing coverage would either be workers or would likely qualify for an exemption based on having a disability, going to school, or other factors. Meanwhile,” they wrote, “research shows — and the CBO previously concluded — that work requirements do not increase employment. Instead, they lead enrollees who lose coverage to take on more medical debt, delay getting needed medical care, and delay taking medications.”
The full analysis can be found here.
