Millions of Americans who rely on Medicaid worry they could lose health insurance if Congress enacts a proposed work requirement. The measure, passed by the U.S. House, would require many able-bodied adults on Medicaid to work, volunteer, or attend school at least 80 hours a month to keep their coverage.
Crystal Strickland of Fairmont, North Carolina, is among those concerned. Strickland, 44, has a heart condition that prevents her from working. She said it took her years to qualify for Medicaid. “What sense does that make?” she asked. “What about the people who can’t work but can’t afford a doctor?”
The work requirement is part of a larger bill backed by former President Donald Trump. The bill, which also aims to cut taxes and government spending, passed the House last month and is now under consideration in the Senate. Trump has called for its passage by July 4.
Supporters argue the requirement would reduce fraud and ensure that taxpayer-funded coverage goes only to those who truly need it. The proposal would exempt people under 19 or over 64, pregnant women, main caregivers of young children, people with disabilities, and those recently released from jail or prison. It would also apply only in states that expanded Medicaid under the 2010 health law.
But many details remain unclear, and that uncertainty is fueling anxiety among Medicaid recipients. Advocates say paperwork and verification requirements could cause many eligible people to lose coverage.
Strickland, who once worked in restaurants and construction, said she went years without seeing a doctor because she couldn’t afford it. At times, she lived in a tent and survived on discarded food. “If they make it harder to get on, they’re not going to be helping,” she said.
Steve Furman worries about his 43-year-old son, who has autism. His son worked for 15 years in an eyeglass plant but struggles with bureaucratic systems. Furman, now retired and living in Arizona, said it took him a year to get his son on Medicaid after they moved. “I don’t know if I should expect the government to take care of him,” Furman said. “But I do expect them to have humanity.”
Today, about 71 million adults are on Medicaid. The vast majority — around 92% — are already working, caregiving, attending school, or living with a disability. A Congressional Budget Office estimate suggests that about 5 million people could lose coverage under the proposal.
A recent KFF poll found that most adults worry Medicaid cuts would leave more people uninsured and strain local health care systems. Nearly half said such cuts could harm their family’s ability to get care.
Critics point to past work requirements in states like Arkansas and Georgia. Studies found these policies reduced Medicaid enrollment without increasing employment.
Amber Bellazaire, a policy analyst with the Michigan League for Public Policy, warned that verifying work hours could create barriers. “Massive coverage losses just due to an administrative burden rather than ineligibility is a significant concern,” she said.
Some enrollees are unsure if they would qualify for exemptions. Lexy Mealing of Westbury, New York, was diagnosed with breast cancer in 2021 and now works about 15 hours a week in gig jobs. She worries the new rules could threaten the coverage she needs for ongoing treatments. “I can’t even imagine going through treatments and not having health insurance,” she said.
Felix White, 61, of Oreland, Pennsylvania, said Medicaid has been life-saving since he lost his job. The program covers his diabetes care and paid for surgeries that saved his foot. “There’s no way I could have afforded that,” White said. “I would have lost my foot and probably died.”
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