The GOP's big bill would bring changes to Medicaid for millions
WASHINGTON —
Republican Sen. Josh Hawley has been clear about his red line as the Senate takes up the GOP's One Big Beautiful Bill Act : no Medicaid cuts.
But what, exactly, would be a cut?
Hawley and other Republicans acknowledge that the main cost-saving provision in the bill – new work requirements on able-bodied adults who receive health care through the Medicaid program -- would cause millions of people to lose their coverage. All told, estimates are 10.9 million fewer people would have health coverage under the bill's proposed changes to Medicaid and the Affordable Care Act. That includes some 8 million fewer in the Medicaid program, including 5.2 million dropping off because of the new eligibility requirements.
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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. 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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. 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"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. 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