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work requirements
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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'Extra Cruel': Trump Admin Ends Job Program for Seniors as Work Requirements Loom
"Many of our participants are living on the edge of poverty," said the head of one organization impacted by the termination of the Senior Community Service Employment Program.
Jul 20, 2025
The Trump administration has reportedly terminated the Department of Labor's only job training program for low-income seniors, a decision that came as older Americans braced for new work reporting requirements under the Republican budget law enacted earlier this month.
Bloomberg Law reported Friday that the Labor Department "quietly ended" its Senior Community Service Employment Program (SCSEP), which helped low-income Americans aged 55 or older find part-time employment or job training at nonprofits and government agencies. The program, described as a bridge to full-time employment, served tens of thousands of people across the country.
Groups that received funding under SCSEP, such as the National Council on Aging and Goodwill Industries, "say the program stopped giving them money after June 30," according to Bloomberg Law, which reported that the Labor Department "hasn't made available the roughly $300 million set aside for national grant recipients."
The Trump White House has proposed zeroing out funding for SCSEP in its budget request for fiscal year 2026, smearing the program as an "earmark to leftist, DEI-promoting entities."
In a July 17 letter to Labor Secretary Lori Chavez-DeRemer and Office of Management and Budget Director Russell Vought, a group of Democratic lawmakers led by Rep. Judy Chu (D-Calif.) warned that the withholding of SCSEP funds has already had "devastating impacts," pointing to program grantees in several states that have been forced to furlough thousands of low-income seniors.
Clayton Fong, president and CEO of the National Asian Pacific Center on Aging, said earlier this month that the funding delay "is not just a bureaucratic issue—it's a crisis for tens of thousands of older adults who depend on SCSEP to survive."
"Many of our participants are living on the edge of poverty," said Fong. "SCSEP gives them purpose, dignity, and the ability to put food on the table. The longer this delay continues, the deeper the harm is."
Bloomberg Law noted that the impact of the ending of SCSEP "could be particularly dire for the thousands of participants who will have to find work or volunteer hours to keep their public health insurance coverage."
"The cruelty is the point," former U.S. Labor Secretary Robert Reich wrote on social media in response to Bloomberg Law's reporting.
Just piling up the bad news today...Our nationwide job training program for low-income seniors has had bipartisan support for decades.It's extra cruel to end it right on the heels of new work requirements to access Medicaid and food assistance.
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— Alt U.S. Department of Labor (@alt-dol.altgov.info) Jul 18, 2025 at 10:15 AM
Millions of older Americans receive health coverage through Medicaid. The AARP Public Policy Institute has estimated that 9 million Medicaid recipients between the ages of 50 and 64 will be subject to the Trump-GOP budget law's work requirements, which mandate that certain enrollees engage in work, job training, or other qualifying activities for at least 80 hours per month—or lose coverage.
The mandates are set to take effect late next year, after the 2026 midterm elections.
The Republican law also expands work requirements for recipients of federal nutrition assistance, raising the age limit for the mandates from 55 to 64. Millions of older adults are enrolled in the Supplemental Nutrition Assistance Program nationwide.
"We believe every American deserves to age with dignity—and that requires affordable access to the basics of life such as food and healthcare," Ramsey Alwin, president and CEO of the National Council on Aging, said earlier this month after Republicans pushed the budget measure through Congress. "This act would put that further out of reach for millions of older Americans in need."
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Bill Would Subject Lawmakers to Same Work Reporting Mandates GOP Just Imposed on Medicaid, SNAP Recipients
"If congressional Republicans think these burdens are appropriate for struggling families, then members of Congress should shoulder them too," said BURDEN Act sponsor Rep. Raja Krishnamoorthi.
Jul 17, 2025
In response to Republicans' new law giving tax breaks to the rich while gutting the social safety net, U.S. Congressman Raja Krishnamoorthi on Thursday introduced legislation that would force members of Congress "to personally comply with the same burdensome work requirement paperwork they imposed on low-income Americans."
Under the Illinois Democrat's Bringing Unfair Reporting Duties to Electeds Now (BURDEN) Act, federal lawmakers "would be barred from enrolling in the Federal Employees Health Benefits Program unless they submit monthly proof of 'community engagement,' the same bureaucratic reporting required of Medicaid recipients," his office said.
Krishnamoorthi's two-page bill would also force members of Congress to file the same paperwork as Supplemental Nutrition Assistance Program (SNAP) recipients to verify eligibility, employment, and income. The proposal comes less than two weeks after President Donald Trump signed congressional Republicans' budget reconciliation package.
During the debate over the GOP megabill, Matt Bruenig, founder of the People's Policy Project, argued in The New York Times that "refusing medical care to people in their time of need based on how much they happened to work the month before is a cruel and pointless policy."
The so-called One Big Beautiful Bill Act is expected to leave 17 million Americans without health insurance, and, according to an Urban Institute analysis, an estimated 22.3 million families are projected to lose some or all of their SNAP benefits.
"President Trump's reckless 'Large Lousy Law' forces millions of vulnerable Americans to jump through hoops just to keep food on the table or get the medical care they need," Krishnamoorthi said in a statement. "If congressional Republicans think these burdens are appropriate for struggling families, then members of Congress should shoulder them too. The BURDEN Act simply says, if you want taxpayer-funded health coverage, prove you meet the same standards you're imposing on the American people."
Krishnamoorthi's bill is unlikely to go anywhere in either the House of Representatives or the Senate, both controlled by the GOP, but it sends a message to the public. His office said that "by exposing the double standard in how burdensome requirements are applied, the BURDEN Act seeks to restore basic fairness and highlight the real-world consequences of Republican policies that target working families."
He introduced the bill amid intense debates among Democratic politicians and their supporters about how to battle Trump and the GOP's agenda and prepare for the 2026 midterm elections, following devastating losses for Democrats in the last cycle.
On Wednesday, the Congressional Progressive Caucus—of which Krishnamoorthi is not a member—announced four task forces as part of an effort to "reclaim the House majority in 2026—with a sharp, populist, pro-working-class agenda that meets the moment."
Similarly but separately, a coalition of labor groups and other progressive organizations on Wednesday launched the Battleground Alliance PAC, a political action committee that plans to pour at least $50 million into flipping the lower chamber for Democrats.
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