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medicaid
Trump’s Big Bill Will Make It Harder for Doctors to Give Patients the Care They Need
Work requirements for Medicaid don’t encourage employment; they punish illness and make recovery harder.
Aug 22, 2025
Like most bright-eyed medical students entering the wards for the first time, I was eager to give my patients the best that modern medicine could offer. This is far from the reality that I was confronted with—one’s insurance status dictated care as much as any guideline, evidence, or well-intentioned physician ever could.
I cared for patients whose chronic illnesses forced them to stop working, only to be told that without a job, they no longer qualified for Medicaid. The logic is cruelly circular: Lose your health, lose your job, lose your care. Work requirements for Medicaid don’t encourage employment; they punish illness and make recovery harder.
Alongside countless peers and healthcare professionals, I was incredibly disheartened on July 4, 2025 as I watched US President Donald Trump sign into law the most sweeping healthcare overhaul since the Affordable Care Act. The 870-page One Big Beautiful Bill Act (OBBBA) is projected to strip health coverage from 11.8 million Americans, leading to an estimated 24,000 preventable deaths each year—driven largely by drastic changes to Medicaid’s administration.
The current administration has long touted work requirements as a fix to Medicaid, having approved 13 Medicaid Section 1115 demonstrations with work requirements in its first term. Unfortunately, it has ignored the failures of these waiver programs and doubled down, making ineffective work requirements the law of the land.
The Majority of Medicaid Recipients Are Already Working
President Trump and his administration have repeatedly stated that the integrity of the Medicaid program needs to be restored, promoting narratives of Medicaid waste, fraud, and abuse. As such, work requirements for “able-bodied” Medicaid recipients were a key provision in the OBBBA. However, in reality, 92% of Medicaid beneficiaries are already working, caring for family, attending school, or living with a disability. Only 8% are “able-bodied” adults not seeking employment.
States Have Tried Work Requirements, They Don’t Work
Arkansas was the only state to have a statewide Medicaid work requirement waiver approved. The results were catastrophic; over 18,000 beneficiaries lost coverage in the four months before a judge ruled that the program could not continue. While enacted, the waiver failed to increase employment; instead implementation was associated with increased Medicaid churn, medical debt, and loss of health coverage.
If the ability to work remains a prerequisite for care, I will spend my career watching patients suffer
For other states, like Michigan and New Hampshire, the path to work requirements was mired with legal challenges. Both states proposed work requirements, which would have resulted in nearly 80,000 and 17,000 beneficiaries losing coverage, respectively, had the programs not been suspended before taking effect.
As of July 2025, Georgia is the only state with active work requirements through the Pathways to Coverage program. Results of this program are similarly underwhelming, with only 8,000 enrolled as of June 2025 after two years of rollout and millions spent in administrative costs. Enrollment falls far short of the projected 64,000 enrollees or the 300,000 to 400,000 Georgians who would qualify for coverage under full Medicaid expansion.
The OBBBA Doubles Down on Failed Policy
The OBBBA will require all states to follow Georgia’s path by 2027. Based on Congressional Budget Office (CBO) estimates, the federal government will save $900 billion in Medicaid spending over the next decade, with work requirements accounting for a third of the reduced spending. These savings come at an enormous cost—approximately 5 million individuals are projected to lose access to Medicaid by 2034, 1.22 million jobs in the healthcare sector will vanish in the next decade, and unemployment will rise by 0.8%. The consequences of this bill will be devastating.
Medicaid Expansion is a Job Promotion Program
Overwhelming evidence suggests Medicaid expansion has reduced uninsurance rates, increased access to healthcare and pharmaceutical care, and improved health outcomes. Moreover, hospitals in expansion states have seen increased Medicaid revenue, decreased costs of uncompensated care, and states themselves have experienced reductions in disease-related deaths, and gains in life expectancy. Importantly, overwhelming evidence shows expansion has no negative effects on workplace engagement, and rather may help increase workplace success.
If the ability to work remains a prerequisite for care, I will spend my career watching patients suffer—not because I lack the skills to help them, but because the system forbids it. Practicing medicine under those rules doesn’t just make my job harder; it risks our patients losing faith in the system altogether.
The evidence is clear, we should be expanding Medicaid, not restricting it, for the good of our patients, our hospitals, and our country.
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Here's a Map of What Trump-GOP Destruction of US Hospitals Looks Like
"Hospitals count on Medicaid to keep their doors open," said healthcare advocacy group Protect Our Care. "Medicaid accounts for one fifth of spending on hospitals, one fifth of hospital discharges, and at least one in five inpatient days in nearly every state."
Aug 21, 2025
The healthcare advocacy organization Protect Our Care has been tracking financially troubled hospitals across the country that are projected to take a big hit thanks to the Medicaid cuts in the massive Republican budget package—and the group has produced a new tool to let people see the damage being done in real time.
The organization on Wednesday launched a new project called "Hospital Crisis Watch" that identifies and provides updates on healthcare facilities around the country at risk of closure thanks to the Medicaid cuts, and produced an interactive map showing exactly which hospitals and medical centers are in danger.
These are all the hospitals in America that are already facing cuts and closures so Trump can give more tax breaks to the rich.
via @ProtectOurCare pic.twitter.com/ws9PqqJWBA
— Americans For Tax Fairness (@4TaxFairness) August 20, 2025
Protect Our Care found that the most vulnerable facilities tend to be in rural areas, identifying 338 endangered rural hospitals throughout the US. The state of Kentucky has the largest concentration of vulnerable hospitals with 35, followed by Louisiana at 33, and California at 28.
In a report about the threats these hospitals face, Protect Our Care explained why Medicaid funding, which the GOP budget package slashed by $1 trillion over the next decade, is vitally important to these institutions' financial well being.
"Hospitals count on Medicaid to keep their doors open," the report said. "Medicaid accounts for one fifth of spending on hospitals, one fifth of hospital discharges, and at least one in five inpatient days in nearly every state."
The report also pointed to an analysis from Commonwealth Fund estimating that more than 475,000 healthcare workers would lose their jobs as a result of the cuts. This would have serious economic ramifications for rural areas given that "hospitals employ 10% of all employees in rural counties that report having any hospital employment," explained Protect Our Care.
Even if these hospitals don't shut down, Protect Our Care warned that they are likely to slash services and increase wait times in emergency rooms.
The potential closure of hospitals isn't the only crisis facing American healthcare. A separate report from Protect Our Care earlier this week documented how health insurance premiums are expected to skyrocket in the coming year unless the Republican-led Congress passes an extension to enhanced subsidies for people who buy their insurance through the exchanges created by the 2010 Affordable Care Act.
Our one big beautiful premium is about to get much bigger https://t.co/reN0uyyiPw
— Ryan Grim (@ryangrim) August 21, 2025
"Because of these GOP policies, insurance companies have already indicated they plan to raise premiums for 24 million Americans by an average of 15%," the group noted. "At the same time, Republicans are ripping away tax credits from 20 million, forcing them to pay an average of 75% more for their coverage. These price hikes will cause countless hard-working families to lose life-saving coverage while millions more will suffer under the already-rising cost of living."
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Trump’s DC Takeover Is a Dangerous Distraction
Trump’s hysterics aside, crime just hit a 30-year low in DC. So why bring it up? Because the last month or two has been jam-packed with stories Trump has been desperate to dodge.
Aug 21, 2025
Credit where it’s due: US President Donald Trump has a talent for getting the chattering classes talking about whatever he wants. Especially when he really doesn’t want them talking about other stuff.
That’s how we should view Trump’s latest drama in Washington, DC, where he mobilized the National Guard and took over the police department.
On the one hand, there’s something new and dangerous about Trump’s willingness to deploy US troops against Americans in their own cities. On the other, scaremongering about cities is a tried and true (and sad!) distraction Republicans have relied on since Richard Nixon.
Trump’s hysterics aside, crime just hit a 30-year low in DC. So why bring it up? Because the last month or two has been jam-packed with stories Trump has been desperate to dodge.
For every National Guard member dispatched to the streets, thousands of families will go to bed without the food or healthcare they need to stay alive.
First, he struggled to escape the shadow of billionaire sex trafficker Jeffrey Epstein. Trump was named repeatedly in the Epstein files, which he’d promised to release before denying they existed at all. The episode led to a rare rupture with his base, with Trump hurling insults at followers upset about his about-face.
Then, troubling economic news piled up.
Food prices are already rising, and news broke that the president’s tariffs could cost each American $2,400 this year alone. July’s job growth was revised downward, leading Trump to fire a professional government economist and install some guy from the Heritage Foundation—who apparently joined the January 6 mob, which Trump pointedly did not want to deploy the Guard against—in her place.
Perhaps most importantly, Americans really, really don’t like the GOP’s budget-busting “Big Beautiful Bill,” which Trump signed this summer. It’s been called “the largest redistribution from poor to rich in American history.” Over 60% of Americans say they oppose it—and the more they learn, the higher that figure climbs.
The law made historically deep cuts to Medicaid and the Supplemental Nutrition Assistance Program to fund tax cuts for billionaires and corporations, plus enormous subsidies for for-profit Pentagon and Immigration and Customs Enforcement contractors. As a result, 17 million Americans will lose their health coverage, killing 51,000 people every year. Millions more will go without food, including children.
Needless to say, Trump and his allies would like to keep these embarrassing facts quiet. So he’s tried a range of distractions. He flirted with filing treason charges against former President Barack Obama. He demanded the Cleveland Guardians go back to the “Indians” name. He fired off one unhinged post after another on social media.
It was only after these gambits and others failed that Trump deployed the troops in DC, delivering a fact-free, all but explicitly racist screed about “crime, bloodshed, bedlam, and squalor” in the nation’s capital.
These claims—dutifully echoed by Fox News and GOP members of Congress—sounded a lot like stuff we’ve heard before. And each time, it’s been an effort to deflect attention from the misdeeds of the powerful and onto a poor, maligned minority.
When the GOP’s poll numbers were faltering ahead of the 2018 or 2022 midterms, we got wave after wave of deceptive ads and stories about “big city crime,” which largely subsided after the vote. When it wasn’t crime, it was a “migrant caravan” or “border crisis.”
Or critical race theory, trans kids, library drag shows, or… well, just fill in the blank.
Sideshows like these aren’t just a pain for fact-checkers. They lead to real threats and violence against these communities—and assaults on all of our freedoms. And they keep us chattering about anything besides the far-right politicians picking our pockets.
For every National Guard member dispatched to the streets, thousands of families will go to bed without the food or healthcare they need to stay alive. That’s the real story of Trump’s America—don’t let him talk you out of it.
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