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 has 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.
For proponents, the ideas behind the work requirement are simple: Crack down on fraud and stand on the principle that taxpayer-provided health coverage isn’t for those who can work but aren’t. The measure includes exceptions for those who are under 19 or over 64, those with disabilities, pregnant women, main caregivers for young children, people recently released from prisons or jails — or during certain emergencies. It would apply only to adults who receive Medicaid through expansions that 40 states chose to undertake as part of the 2010 health insurance overhaul.
Many details of how the changes would work would be developed later, leaving several unknowns and causing anxiety among recipients who worry that their illnesses might not be enough to exempt them.
Advocates and sick and disabled enrollees worry — based largely on their past 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.
Benefits can be difficult to navigate even without a work requirement
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.”
There’s broad reliance on Medicaid for health coverage
About 71 million adults are enrolled in Medicaid now. And most of them — around 92% — are working, caregiving, attending school or disabled. Earlier estimates of the budget bill from the Congressional Budget Office found that about 5 million people stand to lose coverage.
A KFF tracking poll conducted in May found that the enrollees come from across the political spectrum. About one-fourth are Republicans; roughly one-third are Democrats.
The poll found that about 7 in 10 adults are worried that federal spending reductions on Medicaid will lead to more uninsured people and would strain health care providers in their area. About half said they were worried reductions would hurt the ability of them or their family to get and pay for health care.
Amaya Diana, an analyst at KFF, points to work requirements launched in Arkansas and Georgia as keeping people off Medicaid without increasing employment.
Amber Bellazaire, a policy analyst at the Michigan League for Public Policy, said the process to verify that Medicaid enrollees meet the work requirements could be a key reason people would be denied or lose eligibility.
“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.
Some people don’t if they might lose coverage with a work requirement
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.
Mealing, who used to work as a medical receptionist in a pediatric neurosurgeon’s office before her diagnosis and now volunteers for the American Cancer Society, went on Medicaid after going on short-term disability.
“I can’t even imagine going through treatments right now and surgeries and the uncertainty of just not being able to work and not have health insurance,” she said.
Felix White, who has Type I diabetes, first qualified for Medicaid after losing his job as a computer programmer several years ago.
The Oreland, Pennsylvania, man has been looking for a job, but finds that at 61, it’s hard to land one.
Medicaid, meanwhile, pays for a continuous glucose monitor and insulin and funded foot surgeries last year, including one that kept him in the hospital for 12 days.
“There’s no way I could have afforded that,” he said. “I would have lost my foot and probably died.”
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Associated Press writer Susan Haigh in Hartford, Connecticut contributed to this article.
